Organization
BACK TO BASICS DENTAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER CORNELL DDS (OWNER)
(931) 645-8000
Entity
Organization
Contact information
Practice address
1762 HIGHWAY 48, STE A, CLARKSVILLE, TN 37040-7284
(931) 645-8000
Mailing address
1762 HIGHWAY 48, STE A, CLARKSVILLE, TN 37040-7284
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8416
TN
Other
Enumeration date
01/19/2012
Last updated
09/16/2015
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