Provider Demographics
NPI:1538569496
Name:SERENITY DENTAL
Entity type:Organization
Organization Name:SERENITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-444-3932
Mailing Address - Street 1:1030 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3345
Mailing Address - Country:US
Mailing Address - Phone:615-444-3932
Mailing Address - Fax:615-444-5831
Practice Address - Street 1:1030 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3345
Practice Address - Country:US
Practice Address - Phone:615-444-3932
Practice Address - Fax:615-444-5831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1457400996OtherINDIVIDUAL NPI FOR TERESA K. LARKINS, DMD