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General NPI Number Information
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NPI Number | 1902297039
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Entity Type | Organization
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Legal Business Name | CASTLE MID SOUTH DENTAL CENTER PC
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Dates
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Enumeration Date | 02/11/2015
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Last Update Date | 02/11/2015
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Provider Practice Location Address
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Address Line | 305 INDIAN LAKE BLVD STE B260
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-6376
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Country | US
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Telephone | 615-238-6730
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Fax |
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Provider Business Mailing Address
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Address Line | 8415 DATAPOINT DR STE 1020
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3277
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Country | US
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Telephone | 615-238-6730
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIMOTHY MATHIS
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Credential | DDS
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Telephone | 615-238-6730
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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 | 5344
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License Number State | TN
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