Organization
LEBANON PEDIATRIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER SIMS (CREDENTIALING COORDINATOR)
(470) 552-1823
Entity
Organization
Contact information
Practice address
920 S HARTMANN DR, LEBANON, TN 37090-4018
(404) 410-1340
Mailing address
920 S HARTMANN DR, LEBANON, TN 37090-4018
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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