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General NPI Number Information
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NPI Number | 1851904338
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Entity Type | Organization
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Legal Business Name | SOUTH NASHVILLE DENTAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 08/25/2020
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Provider Practice Location Address
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Address Line | 15576 OLD HICKORY BLVD
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City | NASHVILLE
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State | TN
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Zip | 37211-7330
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Country | US
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Telephone | 615-331-5977
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Fax | 615-331-5978
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Provider Business Mailing Address
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Address Line | 15576 OLD HICKORY BLVD
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City | NASHVILLE
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State | TN
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Zip | 37211-7330
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Country | US
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Telephone | 615-331-5977
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Fax | 615-331-5978
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Authorized Official
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Title or Position | OWNER / DENTIST
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Name | DR. RYAN MARK ONEILL
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Credential | DMD
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Telephone | 615-331-5977
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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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