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General NPI Number Information
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NPI Number | 1760181762
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Entity Type | Organization
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Legal Business Name | COMMUNITY CLINIC SHELBYVILLE AND BEDFORD CO.INC.,
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Dates
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Enumeration Date | 02/28/2023
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 200 DOVER ST STE 202
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2799
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Country | US
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Telephone | 931-684-6772
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Fax | 931-684-6721
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Provider Business Mailing Address
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Address Line | 200 DOVER ST STE 202
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City | SHELBYVILLE
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State | TN
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Zip | 37160-2799
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Country | US
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Telephone | 931-684-6772
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Fax | 931-684-6721
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Authorized Official
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Title or Position | DIRECTOR OF DENTAL OPERATIONS
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Name | LISA CARDEN
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Credential |
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Telephone | 931-684-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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