Organization
DENTISTRY AND FASTBRACES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. S ADELE DOHERTY DDS MPH (CEO PRESIDENT)
(615) 851-4744
Entity
Organization
Contact information
Practice address
107 NEW BRICK CHURCH PIKE, SUITE C, GOODLETTSVILLE, TN 37072-1545
(615) 851-4744
Mailing address
107 NEW BRICK CHURCH PIKE, SUITE C, GOODLETTSVILLE, TN 37072-1545
(615) 851-4744
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
4679
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005870
—
TN
Enumeration date
10/15/2005
Last updated
02/12/2015
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