Organization
BLUE RIBBON DENTAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENEAN RESHAY CARR (DENTIST)
(731) 253-9091
Entity
Organization
Contact information
Practice address
211 CHURCH ST, TIPTONVILLE, TN 38079-1109
(731) 253-9091
Mailing address
PO BOX 375, TIPTONVILLE, TN 38079-0375
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
8178
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4120836
BLUE CROSS BLUE SHIELD
TN
05
—
9176548
—
TN
Enumeration date
03/27/2008
Last updated
03/27/2008
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