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1409 West Baddour Parkway Suite F Lebanon TN 37087 | |
| (615) 453-7800 | |
| (615) 453-7858 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1409 West Baddour Parkway, Lebanon, Tennessee |
| Authorized Official Name and Position | Russell Keith Kirk (PRESIDENT) |
| Authorized Official Contact | 6154537800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1409 West Baddour Parkway Suite F Lebanon TN 37087 Ph: (615) 453-7800 | 1409 West Baddour Parkway Suite F Lebanon TN 37087 Ph: (615) 453-7800 |
| NPI Number | 1831361013 |
|---|---|
| Provider Enumeration Date | 03/28/2008 |
| Last Update Date | 05/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831361013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 7103 (Tennessee) | Primary |
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