Full Name | |
---|---|
Speciality | Clinic/center - Dental |
Location | 311 Spring St, Dover, Tennessee |
Authorized Official Name and Position | Jordan Davis (OFFICE MANAGER) |
Authorized Official Contact | 9312327105 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 538 Dover TN 37058-0538 Ph: (931) 232-7105 | 311 Spring St Dover TN 37058-3227 Ph: (931) 232-7105 |
NPI Number | 1104310895 |
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Provider Enumeration Date | 06/18/2018 |
Last Update Date | 06/18/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104310895 | NPI | - | NPPES |
4274444 | Other | TN | BLUE CROSS BLUE SHIELD OF TENNESSEE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 9114 (Tennessee) | Primary |