Organization
KDNASHVILLEDC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYIKA WAN (VP ADMINISTRATIVE SERVICES)
(812) 701-0213
Entity
Organization
Contact information
Practice address
3901 CENTRAL PIKE STE 500, HERMITAGE, TN 37076-3419
(615) 933-7300
Mailing address
9200 SHELBYVILLE RD STE 531, LOUISVILLE, KY 40222-5132
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/04/2023
Last updated
04/30/2025
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