MEDICARE: RESTORATION DENTISTRY

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	1223P0700X	Prosthodontics

General Provider Information

NPI Number	:	1598311573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORATION DENTISTRY

Provider Business Mailing Address
First Line	:	1984 PROVIDENCE PKWY STE 200
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-4459
Country	:	US
Telephone Number	:	615-257-7723
Fax Number	:

Provider Business Practice Location Address
First Line	:	1984 PROVIDENCE PKWY STE 200
Second Line	:
City	:	MT JULIET
State	:	TN
Zip	:	37122-4459
Country	:	US
Telephone Number	:	615-257-7723
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NICHOLAS GREGORY NORVELL
Credential	:	DDS, MDS, CDT
Telephone Number	:	615-804-3960

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	12/09/2019

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Directions to “RESTORATION DENTISTRY ” Practice Location

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