MEDICARE: WARNER PARKS FAMILY DENTAL

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

General Provider Information

NPI Number	:	1598488280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARNER PARKS FAMILY DENTAL

Provider Business Mailing Address
First Line	:	165 BELLE FOREST CIR STE B
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2173
Country	:	US
Telephone Number	:	615-662-2787
Fax Number	:	615-662-1620

Provider Business Practice Location Address
First Line	:	165 BELLE FOREST CIR STE B
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37221-2173
Country	:	US
Telephone Number	:	615-662-2787
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ROBERT WILSON
Credential	:	DMD
Telephone Number	:	615-662-2787

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	07/14/2023

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