MEDICARE: TENNESSEE DENTAL PROFESSIONALS, PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1609653260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE DENTAL PROFESSIONALS, PC

Provider Business Mailing Address
First Line	:	5261 AIRLINE RD
Second Line	:	STE 102
City	:	ARLINGTON
State	:	TN
Zip	:	38002-4267
Country	:	US
Telephone Number	:	901-290-0885
Fax Number	:	901-290-0871

Provider Business Practice Location Address
First Line	:	5261 AIRLINE RD
Second Line	:	STE 102
City	:	ARLINGTON
State	:	TN
Zip	:	38002-4267
Country	:	US
Telephone Number	:	901-290-0885
Fax Number	:	901-290-0871

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	BELINDA HUERTA
Credential	:
Telephone Number	:	217-540-2100

Provider Enumeration Date	:	09/08/2023
Last Update Date	:	01/17/2024

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