# MT JULIET MODERN DENTISTRY PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mt Juliet Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285371187
- **Authorized official:** JENNIFER JUDGE DMD (OWNER)
- **Authorized official phone:** (615) 716-1653

## Contact information

- **Practice address:** 600 S MOUNT JULIET RD STE 3, MOUNT JULIET, TN 37122-6497
- **Practice address phone:** (615) 716-1653
- **Practice address fax:** (615) 866-0615
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (303) 952-0892

## Taxonomy

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

## Other

- **Enumeration date:** 05/13/2022
- **Last updated:** 05/25/2022