Organization
LEBANON FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN RICARDO DANIEL MD, DDS (OWNER)
(615) 830-2176
Entity
Organization
Contact information
Practice address
1430 W BADDOUR PKWY STE B, LEBANON, TN 37087-2656
(931) 704-0834
Mailing address
1430 W BADDOUR PKWY STE B, LEBANON, TN 37087-2656
(931) 704-0834
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
124Q00000X
Dental Hygienist
—
—
Other
Enumeration date
03/11/2024
Last updated
04/16/2024
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