Provider Demographics
NPI:1548434673
Name:PERFECT SMILE ORTHODONTICS PLLC
Entity type:Organization
Organization Name:PERFECT SMILE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-377-1211
Mailing Address - Street 1:317 SEVEN SPRINGS WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4575
Mailing Address - Country:US
Mailing Address - Phone:615-377-1211
Mailing Address - Fax:
Practice Address - Street 1:317 SEVEN SPRINGS WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4575
Practice Address - Country:US
Practice Address - Phone:615-377-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9203425Medicaid