Individual
S ADELE DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
107 NEW BRICK CHURCH PIKE, SUITE C, GOODLETTSVILLE, TN 37072-1545
(615) 851-4744
Mailing address
PO BOX 646, MOUNT JULIET, TN 37121-0646
(615) 851-4744
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4679
TN
122300000X
Dentist
5475
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5870
—
TN
Enumeration date
06/20/2008
Last updated
06/20/2008
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