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General NPI Number Information
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NPI Number | 1770695355
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF CLEVELAND, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 430 STUART RD NE SUITE 1
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City | CLEVELAND
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State | TN
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Zip | 37312-4918
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Country | US
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Telephone | 423-476-2160
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Fax | 423-476-2680
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Provider Business Mailing Address
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Address Line | 150 STUART XING NE
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City | CLEVELAND
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State | TN
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Zip | 37312-4065
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Country | US
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Telephone | 423-476-2160
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Fax | 423-476-2680
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CHAD S ESLINGER
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Credential | DDS
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Telephone | 423-476-2160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7763
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License Number State | TN
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