Organization Name: | ANTIOCH DENTAL |
NPI Number: | 1023498250 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANNY NORTHCUTT (MANAGER) |
Mailing Address: | 616 Bell Rd Antioch |
State: | TN US |
Postal Code: | 370132141 |
Phone Number: | 6153100022 |
Fax Number: | |
NPI Enumeration Date: | 06/03/2015 |
NPI Last Update Date: | 06/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | TN7885 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |