Facts
- Status
- A
- Credential
- DDS
- Type
- Individual
- Enumeration date
- 2006-11-06
- Last updated
- 2007-07-08
Specialties
Licenses
- License TN
- DS0000007676
Location
- Practice location
- 504 N JACKSON ST, SUITE 103
- City
- TULLAHOMA TN
- Postal code
- 373883520
- Phone
- 931-461-9030
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.