Provider Demographics
NPI:1730290255
Name:HERMITAGE FAMILY & COSMETIC DENTISTRY, P.C.
Entity type:Organization
Organization Name:HERMITAGE FAMILY & COSMETIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-872-7762
Mailing Address - Street 1:260 JACKSON MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1425
Mailing Address - Country:US
Mailing Address - Phone:615-872-7762
Mailing Address - Fax:
Practice Address - Street 1:260 JACKSON MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1425
Practice Address - Country:US
Practice Address - Phone:615-872-7762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82441223G0001X
TN50161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty