Organization
CHARTER OAK ENDODONTICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAMARA GRAVELY-GRIFFIN D.M.D. , M.S. (PRESIDENT)
(615) 339-6592
Entity
Organization
Contact information
Practice address
1926 HIGHWAY 46 S, DICKSON, TN 37055-2754
(615) 446-7050
Mailing address
PO BOX 3086, BRENTWOOD, TN 37024-3086
(615) 339-6592
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
8079
TN
Other
Enumeration date
06/05/2007
Last updated
08/29/2007
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