Organization
TW NEW DENTISTRY, PLLC
Active
Parent organization
TAILWATER, LLC
Other names
New Dentistry
Organization subpart
Yes
Provider details
NPI number
Legal business name
TAILWATER, LLC
Authorized official
MR. RYAN MCCOSTLIN (CEO)
(615) 479-2196
Entity
Organization
Contact information
Practice address
7828 KINGSTON PIKE, KNOXVILLE, TN 37919-5520
(865) 693-8131
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
11/22/2021
Last updated
11/22/2021
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