# TENNESSEE DENTAL PROFESSIONALS PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TENNESSEE DENTAL PROFESSIONALS PC
- **Other names:** Paddock Place Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1023313533
- **Legal business name:** TENNESSEE DENTAL PROFESSIONALS PC
- **Authorized official:** KAM SHICK (INSURANCE COORDINATOR)
- **Authorized official phone:** (217) 540-5100

## Contact information

- **Practice address:** 20 OLD PLEASANT GROVE ROAD, SUITE 100, MOUNT JULIET, TN 37122-3880
- **Practice address phone:** (615) 758-4807
- **Mailing address:** 20 OLD PLEASANT GROVE ROAD, SUITE 100, MOUNT JULIET, TN 37122-3880
- **Mailing address phone:** (615) 758-4807

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 01/13/2011
- **Last updated:** 09/17/2014