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General NPI Number Information
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NPI Number | 1902124746
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Entity Type | Organization
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Legal Business Name | EAST SIDE SMILES
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 7 N 10TH ST
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City | NASHVILLE
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State | TN
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Zip | 37206-3501
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Country | US
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Telephone | 615-227-2400
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Fax | 615-227-2452
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Provider Business Mailing Address
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Address Line | 7 N 10TH ST
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City | NASHVILLE
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State | TN
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Zip | 37206-3501
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Country | US
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Telephone | 615-227-2400
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Fax | 615-227-2452
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Authorized Official
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Title or Position | OWNER
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Name | DR. THOMAS HADLEY
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Credential | D.D.S.
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Telephone | 615-227-2400
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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 | 8243
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License Number State | TN
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