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Organization
COOKEVILLE REGIONAL DENTAL ASSOCIATES
Active
Organization
COOKEVILLE REGIONAL DENTAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA ANN JOHNSON CDA, RDA (OFFICE MANAGER)
(931) 528-5105
Entity
Organization
Contact information
Practice address
327 N CEDAR AVE, COOKEVILLE, TN 38501-2420
(931) 528-5105
(931) 528-5118
Mailing address
PO BOX 357, COOKEVILLE, TN 38503-0357
(931) 528-5105
(931) 528-5118
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
NULL
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
08/31/2005
Last updated
01/10/2008
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