MEDICARE: TEAM POPP 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4125	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7499386	OTHER	TN	UNITED CONCORDIA
2	0017078	OTHER	TN	DORAL
3	0017079	OTHER	TN	DORAL
4	0039969	OTHER	TN	BCBS OF TN
5	4024712	OTHER	TN	BCBS OF TN
6	3072971	OTHER	TN	BCBS OF TN
7	820674	OTHER	TN	UNITED CONCORDIA

General Provider Information

NPI Number	:	1841383437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM POPP DENTAL, PLLC

Provider Business Mailing Address
First Line	:	4211 HIXSON PIKE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415
Country	:	US
Telephone Number	:	423-870-8787
Fax Number	:	423-875-6489

Provider Business Practice Location Address
First Line	:	4211 HIXSON PIKE
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415
Country	:	US
Telephone Number	:	423-870-8787
Fax Number	:	423-875-6489

Authorized Official
Title or Position	:	OWNER
Name	:	THOMAS W POPP
Credential	:	DDS, MSD
Telephone Number	:	423-870-8787

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/18/2022

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Directions to “TEAM POPP DENTAL, PLLC ” Practice Location

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