Provider Demographics
NPI:1730778044
Name:EAST RIDGE FAMILY DENTAL
Entity type:Organization
Organization Name:EAST RIDGE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-629-6015
Mailing Address - Street 1:3823 RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:EAST RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37412-1639
Mailing Address - Country:US
Mailing Address - Phone:423-629-6015
Mailing Address - Fax:
Practice Address - Street 1:3823 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:EAST RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37412-1639
Practice Address - Country:US
Practice Address - Phone:423-629-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty