Provider Demographics
NPI:1861603508
Name:BRENTWOOD DENTAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:BRENTWOOD DENTAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-9889
Mailing Address - Street 1:1607 WESTGATE CIR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8075
Mailing Address - Country:US
Mailing Address - Phone:615-373-9889
Mailing Address - Fax:615-425-0320
Practice Address - Street 1:1607 WESTGATE CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-8075
Practice Address - Country:US
Practice Address - Phone:615-373-9889
Practice Address - Fax:615-425-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty