Organization
SPARK DENTAL TN, PLLC
Active
Parent organization
SPARK DENTAL TN, PLLC
Other names
Cumberland Pediatric Dentistry, Tri-Cities Orthodontic Specialists, Cumberland Pediatric Dentistry and Orthodontics
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPARK DENTAL TN, PLLC
Authorized official
CAROL LYNN GOINGS (REGIONAL MANAGER)
(615) 478-7166
Entity
Organization
Contact information
Practice address
1540 ROCK SPRINGS RD, SMYRNA, TN 37167-6141
(615) 930-3718
(615) 625-3473
Mailing address
1540 ROCK SPRINGS RD, SMYRNA, TN 37167-6141
(615) 930-3718
(615) 625-3473
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q070323
—
TN
Enumeration date
11/13/2021
Last updated
03/11/2022
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