Provider Demographics
NPI:1730800343
Name:TENNESSEE FAMILY DENTAL CARE- MIDTOWN PLLC
Entity type:Organization
Organization Name:TENNESSEE FAMILY DENTAL CARE- MIDTOWN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-388-5832
Mailing Address - Street 1:2106 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1816
Mailing Address - Country:US
Mailing Address - Phone:615-321-2702
Mailing Address - Fax:616-469-1036
Practice Address - Street 1:2106 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1816
Practice Address - Country:US
Practice Address - Phone:615-321-2702
Practice Address - Fax:616-469-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental