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General NPI Number Information
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NPI Number | 1962811653
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Entity Type | Organization
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Legal Business Name | BROGDON DENTAL PC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 3920 DAYTON BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-2716
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Country | US
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Telephone | 423-870-5698
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Fax |
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Provider Business Mailing Address
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Address Line | 3920 DAYTON BLVD
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City | CHATTANOOGA
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State | TN
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Zip | 37415-2716
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Country | US
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Telephone | 423-870-5698
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | JOSEPH BROGDON
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Credential | DDS
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Telephone | 423-870-5698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4202
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License Number State | TN
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