# HENDERSONVILLE DENTAL SPA FOR KIDS PLLC

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

## Provider details

- **NPI number:** 1649635947
- **Authorized official:** DR. LANCE H HARRISON JR. DDS (GENERAL DENTIST)
- **Authorized official phone:** (615) 991-5903

## Contact information

- **Practice address:** 264 NEW SHACKLE ISLAND RD STE 105B, HENDERSONVILLE, TN 37075-2482
- **Practice address phone:** (615) 991-5903
- **Practice address fax:** (615) 991-5199
- **Mailing address:** 264 NEW SHACKLE ISLAND RD STE 105B, HENDERSONVILLE, TN 37075-2482
- **Mailing address phone:** (615) 991-5903
- **Mailing address fax:** (615) 991-5199

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8737 | TN | Yes |

## Other

- **Enumeration date:** 12/31/2015
- **Last updated:** 12/31/2015