=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952618266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCESS DENTAL OF BRENTWOOD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2010
-----------------------------------------------------
Last Update Date | 09/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 PENN WARREN DR STE 500
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-371-6446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 PENN WARREN DR STE 500
-----------------------------------------------------
City | BRENTWOOD
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37027-5089
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-371-6446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. VICTOR C BECK
-----------------------------------------------------
Credential | D.D.S
-----------------------------------------------------
Telephone | 615-371-6446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 002530
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------