Organization
PROSPERITY COSMETIC & GENERAL DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRENDA LESIA MOORE II DDS (DENTIST)
(615) 720-3765
Entity
Organization
Contact information
Practice address
908 34TH AVE N, SUITE A, NASHVILLE, TN 37209-2502
(615) 720-3765
(615) 327-0546
Mailing address
908 34TH AVE N, SUITE A, NASHVILLE, TN 37209-2502
(615) 720-3765
(615) 327-0546
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
8455
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5440336
—
TN
Enumeration date
04/15/2008
Last updated
04/15/2008
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