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Organization
COLLEGEDALE FAMILY DENTISTRY P.C.
Active
Organization
COLLEGEDALE FAMILY DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID PETERSON DDS (OWNER DENTIST)
(423) 396-4222
Entity
Organization
Contact information
Practice address
9325 APISON PIKE STE 119, OOLTEWAH, TN 37363-3802
(423) 396-4222
Mailing address
9325 APISON PIKE STE 119, OOLTEWAH, TN 37363-3802
(423) 396-4222
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11462
DENTIST
TN
Enumeration date
03/24/2021
Last updated
03/24/2021
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