Organization
BRENTWOOD DENTAL SPECIALISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY JO OGLES (OFFICE MANAGER)
(615) 373-9889
Entity
Organization
Contact information
Practice address
1642 WESTGATE CIR, SUITE 100, BRENTWOOD, TN 37027-8194
(615) 373-9889
(615) 425-0320
Mailing address
1642 WESTGATE CIR, SUITE 100, BRENTWOOD, TN 37027-8194
(615) 373-9889
(615) 425-0320
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8056
TN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
8055
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3206481
—
TN
Enumeration date
07/19/2011
Last updated
07/19/2011
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