=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952866212
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORNERSTONE FAMILY DENTISTRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2019
-----------------------------------------------------
Last Update Date | 01/31/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 404 WELSHWOOD DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-4287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-333-3382
-----------------------------------------------------
Fax | 615-832-1293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 404 WELSHWOOD DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-4287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-333-3382
-----------------------------------------------------
Fax | 615-832-1293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT AND OWNER
-----------------------------------------------------
Name | DR. WHITNEY L WILSON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 615-569-1901
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------