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2805 Old Fort Pkwy Murfreesboro TN 37128-5115 | |
| (615) 987-0505 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2805 Old Fort Pkwy, Murfreesboro, Tennessee |
| Authorized Official Name and Position | Amy Roeder (PRESIDENT/DENTIST) |
| Authorized Official Contact | 6154145994 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2805 Old Fort Pkwy Suite A Murfreesboro TN 37128-5115 Ph: (615) 987-0505 | 2805 Old Fort Pkwy Murfreesboro TN 37128-5115 Ph: (615) 987-0505 |
| NPI Number | 1801329917 |
|---|---|
| Provider Enumeration Date | 04/05/2017 |
| Last Update Date | 04/05/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801329917 | NPI | - | NPPES |
| 1526301 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 7891 (Tennessee) | Primary |
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