# TOOTH EXTRACTION CLINIC

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

## Provider details

- **NPI number:** 1568120160
- **Authorized official:** DR. JOHNNY WILLIAMS DMD (COO)
- **Authorized official phone:** (615) 447-5011

## Contact information

- **Practice address:** 264 NEW SHACKLE ISLAND RD STE 105A, HENDERSONVILLE, TN 37075-2482
- **Practice address phone:** (615) 447-5011
- **Mailing address:** 264 NEW SHACKLE ISLAND RD STE 105A, HENDERSONVILLE, TN 37075-2482
- **Mailing address phone:** (615) 447-5011

## Taxonomy

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

## Other

- **Enumeration date:** 12/01/2021
- **Last updated:** 12/01/2021