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Dental Providers Dentist General Practice

Provider NPI: 1275611600

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
703 N. MAIN ST.  MT. PLEASANT, TN 38474 US
Tel: 931-379-7711  Fax: 931-379-7729

Business Mailing Address:
P.O. BOX 232  MT. PLEASANT, TN 38474 US
Tel: 931-379-7711  Fax: 931-379-7729

NPI Information:
NPI: 1275611600
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N1223G0001XDental Providers
General Practice
Y1223D0001XDental Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 1223D0001X





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