MEDICARE: BELLEVUE DENTAL CARE, PC

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	1223G0001X	General Practice Dentistry	7002	TN

General Provider Information

NPI Number	:	1164554168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLEVUE DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	7041 HIGHWAY 70 S
Second Line	:	SUITE 106
City	:	NASHVILLE
State	:	TN
Zip	:	37221-5238
Country	:	US
Telephone Number	:	615-662-7878
Fax Number	:	615-662-9919

Provider Business Practice Location Address
First Line	:	7041 HIGHWAY 70 S
Second Line	:	SUITE 106
City	:	NASHVILLE
State	:	TN
Zip	:	37221-5238
Country	:	US
Telephone Number	:	615-662-7878
Fax Number	:	615-662-9919

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMIE SUE GROSS
Credential	:	DMD
Telephone Number	:	615-662-7878

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	05/27/2014

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