Organization
TAILWATER PRACTICE PARTNERS
Active
Parent organization
TW NEW DENTISTRY, PLLC
Other names
Rolla Family Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
TW NEW DENTISTRY, PLLC
Authorized official
MR. RYAN MCCOSTLIN (CEO)
(615) 479-2196
Entity
Organization
Contact information
Practice address
1701 E 10TH ST, ROLLA, MO 65401-4601
(573) 364-1599
Mailing address
10 BURTON HILLS BLVD STE 400, NASHVILLE, TN 37215-3004
(615) 479-2196
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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