MEDICARE: TENNESSEE VALLEY DENTAL PARTNERS, P.C.

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	:	1629688338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE VALLEY DENTAL PARTNERS, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 58968
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-8968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 NASHVILLE HWY STE 102
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-2016
Country	:	US
Telephone Number	:	615-435-3888
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN LUCAS
Credential	:	DDS
Telephone Number	:	615-435-3888

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	08/06/2020

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