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5505 Edmondson Pike Suite 201 Nashville TN 37211-5872 | |
| (615) 331-0402 | |
| (615) 832-5410 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 5505 Edmondson Pike, Nashville, Tennessee |
| Authorized Official Name and Position | Joseph A. Otterpohl (OWNER) |
| Authorized Official Contact | 6153310402 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5505 Edmondson Pike Suite 201 Nashville TN 37211-5872 Ph: (615) 331-0402 | 5505 Edmondson Pike Suite 201 Nashville TN 37211-5872 Ph: (615) 331-0402 |
| NPI Number | 1043568595 |
|---|---|
| Provider Enumeration Date | 08/15/2012 |
| Last Update Date | 08/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043568595 | NPI | - | NPPES |
| 1619232881 | Other | TN | NPI |
| 1881789568 | Other | TN | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DS3687 (Kentucky) | Primary |
| 1223G0001X | Dentist - General Practice | DS9497 (Tennessee) | Secondary |
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