Organization
PROMISE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY DIANE BUSH (DOCTOR'S WIFE)
(615) 401-1103
Entity
Organization
Contact information
Practice address
2908 SIDCO DR, NASHVILLE, TN 37204-3759
(615) 401-1103
(615) 678-4381
Mailing address
2908 SIDCO DR, NASHVILLE, TN 37204-3759
(615) 401-1103
(615) 678-4381
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS3134
TN
Other
Enumeration date
09/25/2013
Last updated
09/25/2013
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