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General NPI Number Information
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NPI Number | 1659668226
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Entity Type | Organization
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Legal Business Name | PERIODONTAL CARE CENTER, PLLC
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Dates
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Enumeration Date | 07/05/2011
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 100 SPRINGHOUSE CT SUITE 220
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1609
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Country | US
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Telephone | 615-264-6404
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Fax |
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Provider Business Mailing Address
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Address Line | 100 SPRINGHOUSE CT SUITE 220
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-1609
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Country | US
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Telephone | 615-264-6404
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN-MAX JEAN-PIERRE
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Credential | DDS
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Telephone | 615-264-6404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 8167
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License Number State | TN
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