# SOUTHEASTERN DENTAL OF MT JULIET PLLC

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

## Provider details

- **NPI number:** 1568021285
- **Authorized official:** VICKIE METCALF (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (615) 568-3258

## Contact information

- **Practice address:** 631 S MOUNT JULIET RD, MT JULIET, TN 37122-6319
- **Practice address phone:** (615) 754-6677
- **Practice address fax:** (615) 773-5002
- **Mailing address:** 631 S MOUNT JULIET RD, MT JULIET, TN 37122-6319
- **Mailing address phone:** (615) 754-6677
- **Mailing address fax:** (615) 773-5002

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/06/2019
- **Last updated:** 06/06/2019