Organization
EAST BRAINERD FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MCDOWELL HOOPER III D.D.S. (CO OWNER)
(423) 892-8169
Entity
Organization
Contact information
Practice address
8190 E BRAINERD RD, CHATTANOOGA, TN 37421-4301
(423) 892-8169
Mailing address
8190 E BRAINERD RD, CHATTANOOGA, TN 37421-4301
(423) 892-8169
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8262
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6951150001
MEDICARE DMEPOS
TN
Enumeration date
05/14/2008
Last updated
01/21/2014
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