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Organization

SOUTHEASTERN DENTAL OF MT JULIET PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VICKIE METCALF (PRACTICE ADMINISTRATOR)
(615) 568-3258
Entity
Organization

Contact information

Practice address
631 S MOUNT JULIET RD, MT JULIET, TN 37122-6319
(615) 754-6677
(615) 773-5002
Mailing address
631 S MOUNT JULIET RD, MT JULIET, TN 37122-6319
(615) 754-6677
(615) 773-5002

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1164592226
DARREN FOSTER, DDS
01
1700203007
R. W. ARCHER
01
1932652302
KINJAL VORA, DDS
Enumeration date
06/06/2019
Last updated
06/06/2019
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