| Tennessee Dental Corporation | |
|
414 Tennessee St Redlands CA 92373-8163 | |
| (909) 798-4000 | |
| Not Available |
| Full Name | Tennessee Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 414 Tennessee St, Redlands, California |
| Authorized Official Name and Position | Epifania V Nicolas (CEO) |
| Authorized Official Contact | 7149069116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tennessee Dental Corporation 414 Tennessee St Ste K1 Redlands CA 92373-8152 Ph: (909) 798-4000 | Tennessee Dental Corporation 414 Tennessee St Redlands CA 92373-8163 Ph: (909) 798-4000 |
| NPI Number | 1417301060 |
|---|---|
| Provider Enumeration Date | 04/20/2016 |
| Last Update Date | 11/13/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417301060 | NPI | - | NPPES |
| B4029004 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 40290 (California) | Primary |
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