Organization
COOKEVILLE REGIONAL DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REGINA ANN JOHNSON CDA, EFDA (OFFICE MANAGER)
(931) 528-5105
Entity
Organization
Contact information
Practice address
327 N CEDAR AVE, COOKEVILLE, TN 38501-2420
(931) 528-5105
(931) 528-5118
Mailing address
327 N CEDAR AVE, COOKEVILLE, TN 38501-2420
(931) 528-5105
(931) 528-5118
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
TN
1223P0221X
Pediatric Dentistry
—
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
TN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
TN
Other
Enumeration date
07/21/2008
Last updated
06/14/2016
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