MEDICARE: NASHVILLE ORTHODONTIC ASSOCIATES 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	261QD0000X	Dental Clinic/Center	9105	TN

General Provider Information

NPI Number	:	1376908566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASHVILLE ORTHODONTIC ASSOCIATES PLLC

Provider Business Mailing Address
First Line	:	4219 HILLSBORO PIKE
Second Line	:	STE 103
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3316
Country	:	US
Telephone Number	:	615-297-6997
Fax Number	:

Provider Business Practice Location Address
First Line	:	4219 HILLSBORO PIKE
Second Line	:	STE 103
City	:	NASHVILLE
State	:	TN
Zip	:	37215-3328
Country	:	US
Telephone Number	:	615-297-6997
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ANTHONY DITCHARO
Credential	:
Telephone Number	:	615-297-6997

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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