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General NPI Number Information
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NPI Number | 1780492298
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH ENDODONTICS PLLC
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 40 W CALDWELL ST STE 203
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City | MT JULIET
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State | TN
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Zip | 37122-3179
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Country | US
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Telephone | 615-808-0027
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Fax |
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Provider Business Mailing Address
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Address Line | 40 W CALDWELL ST STE 203
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City | MT JULIET
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State | TN
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Zip | 37122-3179
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Country | US
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Telephone | 615-808-0027
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | RICHARD JOSEPH HORWAT
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Credential | OWNER/D.M.D.
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Telephone | 615-707-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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