MEDICARE: MH DMD OF TENNESSEE, PLLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1285191767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MH DMD OF TENNESSEE, PLLC

Provider Business Mailing Address
First Line	:	2126 ABBOTT MARTIN RD STE 168
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2619
Country	:	US
Telephone Number	:	650-649-9497
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 ABBOTT MARTIN RD STE 168
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2619
Country	:	US
Telephone Number	:	800-674-9732
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	MR. MARTIN BREMER
Credential	:
Telephone Number	:	650-649-9497

Provider Enumeration Date	:	02/21/2019
Last Update Date	:	02/21/2019

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