MEDICARE: WOODBINE DENTAL 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	122300000X	Dentist

General Provider Information

NPI Number	:	1396621736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODBINE DENTAL PLLC

Provider Business Mailing Address
First Line	:	1815 STUART AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-4374
Country	:	US
Telephone Number	:	423-472-4621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 STUART AVE NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-4374
Country	:	US
Telephone Number	:	423-504-9513
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ALEXANDER HARRIS
Credential	:	DDS
Telephone Number	:	423-472-4621

Provider Enumeration Date	:	08/12/2025
Last Update Date	:	06/04/2026

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