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General NPI Number Information
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NPI Number | 1659674315
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Entity Type | Organization
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Legal Business Name | EASTDALE FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 3210 WILCOX BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-1071
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Country | US
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Telephone | 423-622-4869
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Fax | 423-622-4875
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Provider Business Mailing Address
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Address Line | 3210 WILCOX BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37411-1071
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Country | US
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Telephone | 423-622-4869
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Fax | 423-622-4875
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THOMAS C. RUMPH JR.
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Credential | DMD
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Telephone | 423-622-4869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4119 DS
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License Number State | TN
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