# CENTERVILLE DENTAL

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

## Provider details

- **NPI number:** 1174881965
- **Authorized official:** DR. JAMIE M LEE DDS (OWNER)
- **Authorized official phone:** (931) 729-2664

## Contact information

- **Practice address:** 704 HIGHWAY 100, STE 101, CENTERVILLE, TN 37033-1171
- **Practice address phone:** (931) 729-2664
- **Practice address fax:** (931) 729-2666
- **Mailing address:** 704 HIGHWAY 100, STE 101, CENTERVILLE, TN 37033-1171
- **Mailing address phone:** (931) 729-2664
- **Mailing address fax:** (931) 729-2666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8074 | TN | Yes |

## Other

- **Enumeration date:** 04/30/2012
- **Last updated:** 04/30/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5441233 | — | TN |