# COUNTRY CREEK DENTAL PLLC

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

## Provider details

- **NPI number:** 1306357447
- **Authorized official:** DR. NATHAN LA MONICA DMD (DENTIST)
- **Authorized official phone:** (775) 291-0075

## Contact information

- **Practice address:** 207 KINGS CT, ALCOA, TN 37701-1939
- **Practice address phone:** (865) 983-6361
- **Mailing address:** 7605 GILMORE LN, CORRYTON, TN 37721-4128
- **Mailing address phone:** (775) 291-0075

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 10031 | TN | Yes |

## Other

- **Enumeration date:** 10/16/2017
- **Last updated:** 10/16/2017