# CD TENNESSEE DENTAL, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Radiant Smiles Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083263586
- **Authorized official:** TY JUSTICE (DIRECTOR, PAYER RELATIONS)
- **Authorized official phone:** (513) 808-4984

## Contact information

- **Practice address:** 103 CUDE LN, MADISON, TN 37115-2201
- **Practice address phone:** (615) 851-7999
- **Practice address fax:** (615) 851-8491
- **Mailing address:** 9825 KENWOOD RD STE 200, BLUE ASH, OH 45242-6252
- **Mailing address phone:** (513) 808-4984
- **Mailing address fax:** (513) 448-0511

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/06/2019
- **Last updated:** 05/03/2023