Provider Demographics
NPI:1538605696
Name:CORNERSTONE FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:CORNERSTONE FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-592-4404
Mailing Address - Street 1:404 WELSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4287
Mailing Address - Country:US
Mailing Address - Phone:615-333-3382
Mailing Address - Fax:615-832-1293
Practice Address - Street 1:404 WELSHWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4287
Practice Address - Country:US
Practice Address - Phone:615-333-3382
Practice Address - Fax:615-832-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty