# EAST BRAINERD FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033386313
- **Authorized official:** DR. CHARLES MCDOWELL HOOPER III D.D.S. (CO OWNER)
- **Authorized official phone:** (423) 892-8169

## Contact information

- **Practice address:** 8190 E BRAINERD RD, CHATTANOOGA, TN 37421-4301
- **Practice address phone:** (423) 892-8169
- **Mailing address:** 8190 E BRAINERD RD, CHATTANOOGA, TN 37421-4301
- **Mailing address phone:** (423) 892-8169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8262 | TN | Yes |

## Other

- **Enumeration date:** 05/14/2008
- **Last updated:** 01/21/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 6951150001 | MEDICARE DMEPOS | TN |