Organization
NORTH RIVER PERIO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RHONDA M WEST (INSURANCE MANAGER)
(423) 870-9567
Entity
Organization
Contact information
Practice address
5022 OLD GODSEY LN STE 1, HIXSON, TN 37343-6604
(423) 870-9567
(423) 870-5331
Mailing address
5022 OLD GODSEY LN STE 1, HIXSON, TN 37343-6604
(423) 870-9567
(423) 870-5331
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
7108
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720292907
CHARLES L MCBRAYER DDS
TN
Enumeration date
07/02/2018
Last updated
07/02/2018
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