MEDICARE: DENTAL BLISS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4127	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4127	OTHER	TN	TN DENTAL LICENSE NUMBER

General Provider Information

NPI Number	:	1134553829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL BLISS, P.C.

Provider Business Mailing Address
First Line	:	151 ROSA HELM WAY
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8413
Country	:	US
Telephone Number	:	615-794-8810
Fax Number	:	615-794-2929

Provider Business Practice Location Address
First Line	:	151 ROSA HELM WAY
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-8413
Country	:	US
Telephone Number	:	615-794-8810
Fax Number	:	615-794-2929

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL A ATCHLEY
Credential	:	D.D.S.
Telephone Number	:	615-794-8810

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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