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Organization
EAST BRAINERD FAMILY DENTISTRY PLLC
Active
Organization
EAST BRAINERD FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MCDOWELL HOOPER III D.D.S. (CO OWNER)
(423) 892-8169
Entity
Organization
Contact information
Practice address
8190 E BRAINERD RD, CHATTANOOGA, TN 37421-4301
(423) 892-8169
Mailing address
8190 E BRAINERD RD, CHATTANOOGA, TN 37421-4301
(423) 892-8169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8262
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6951150001
MEDICARE DMEPOS
TN
Enumeration date
05/14/2008
Last updated
01/21/2014
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