# HERMITAGE PEDIATRIC DENTISTRY

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

## Provider details

- **NPI number:** 1174852958
- **Authorized official:** DR. KIRKLAND E LARSON D.D.S (DENTIST)
- **Authorized official phone:** (615) 889-1654

## Contact information

- **Practice address:** 107 BONNABROOK DR, HERMITAGE, TN 37076-1910
- **Practice address phone:** (615) 889-1654
- **Practice address fax:** (615) 316-9197
- **Mailing address:** 107 BONNABROOK DR, HERMITAGE, TN 37076-1910
- **Mailing address phone:** (615) 889-1654
- **Mailing address fax:** (615) 316-9197

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 8202 | TN | Yes |

## Other

- **Enumeration date:** 12/08/2009
- **Last updated:** 12/08/2009