Organization
SANGO SMILES PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRYSTAL RUCKER DMD (OWNER)
(615) 557-4442
Entity
Organization
Contact information
Practice address
2622 MADISON ST STE G, CLARKSVILLE, TN 37043-6555
(931) 919-4898
(931) 919-4892
Mailing address
7520 LORDS CHAPEL DR, NASHVILLE, TN 37211-7040
(615) 557-4442
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
8466
TN
Other
Enumeration date
10/10/2017
Last updated
10/10/2017
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