| Organization Name: | GERMANTOWN DENTAL GROUP |
| NPI Number: | 1003927310 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BETHANY OLIVER FOSTER (OFFICE MANAGER) |
| Mailing Address: | 2165 West St Germantown |
| State: | TN US |
| Postal Code: | 38138 |
| Phone Number: | 9017540540 |
| Fax Number: | 9017540621 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 10/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | DS7364 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |