# PROVIDENCE DENTAL CARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LaFever Enterprises, Inc.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447352372
- **Authorized official:** DR. LARRY WAYNE LAFEVER D.D.S (PRESIDENT)
- **Authorized official phone:** (615) 758-6800

## Contact information

- **Practice address:** 684 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-3323
- **Practice address phone:** (615) 758-6800
- **Practice address fax:** (615) 758-8419
- **Mailing address:** 684 N MOUNT JULIET RD, MOUNT JULIET, TN 37122-3323
- **Mailing address phone:** (615) 758-6800
- **Mailing address fax:** (615) 758-8419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | DS0000004058 | TN | Yes |

## Other

- **Enumeration date:** 09/01/2006
- **Last updated:** 01/05/2017