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General NPI Number Information
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NPI Number | 1801303854
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Entity Type | Organization
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Legal Business Name | CHRYSALIS ORAL HEALTH CARE ALLIANCE
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 12/29/2017
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Provider Practice Location Address
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Address Line | 326 21ST AVE N
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City | NASHVILLE
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State | TN
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Zip | 37203-1846
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Country | US
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Telephone | 615-714-6182
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Fax |
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Provider Business Mailing Address
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Address Line | 900 BELDEN WAY
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City | NASHVILLE
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State | TN
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Zip | 37221-4433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | DR. HIMANSHU PATEL
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Credential | DMD
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Telephone | 615-714-6182
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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 | 10097
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License Number State | TN
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