# NOTHSIDE DENTAL CENTER, PA

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

## Provider details

- **NPI number:** 1700851979
- **Authorized official:** DR. FRANK H HAMPSON D.D.S. (SECRETARY/TREASURER)
- **Authorized official phone:** (731) 668-7916

## Contact information

- **Practice address:** 3067 N HIGHLAND AVE, JACKSON, TN 38305-3411
- **Practice address phone:** (731) 668-7916
- **Practice address fax:** (731) 668-9544
- **Mailing address:** 3067 N HIGHLAND AVE, JACKSON, TN 38305-3411
- **Mailing address phone:** (731) 668-7916
- **Mailing address fax:** (731) 668-9544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/21/2006
- **Last updated:** 06/26/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0149768 | BLUE CROSS BLUE SHIELD TN | TN |