| Tn Southern Dental Ppo | |
|
761 Old Hickory Blvd Ste 100 Brentwood TN 37027-4519 | |
| (615) 377-0111 | |
| Not Available |
| Full Name | Tn Southern Dental Ppo |
|---|---|
| Speciality | Dentist |
| Location | 761 Old Hickory Blvd Ste 100, Brentwood, Tennessee |
| Authorized Official Name and Position | Erika Melissa Menjivar (SR. CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 4695966137 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tn Southern Dental Ppo 5830 Granite Pkwy Ste 780 Plano TX 75024-6775 Ph: () - | Tn Southern Dental Ppo 761 Old Hickory Blvd Ste 100 Brentwood TN 37027-4519 Ph: (615) 377-0111 |
| NPI Number | 1609680701 |
|---|---|
| Provider Enumeration Date | 02/07/2025 |
| Last Update Date | 02/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609680701 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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