# TAILWATER PRACTICE PARTNERS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TW NEW DENTISTRY, PLLC
- **Other names:** Rolla Family Dentistry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1073393336
- **Legal business name:** TW NEW DENTISTRY, PLLC
- **Authorized official:** MR. RYAN MCCOSTLIN (CEO)
- **Authorized official phone:** (615) 479-2196

## Contact information

- **Practice address:** 1701 E 10TH ST, ROLLA, MO 65401-4601
- **Practice address phone:** (573) 364-1599
- **Mailing address:** 10 BURTON HILLS BLVD STE 400, NASHVILLE, TN 37215-3004
- **Mailing address phone:** (615) 479-2196

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/04/2023
- **Last updated:** 10/04/2023