Organization
ORAL PATHOLOGY DIAGNOSTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA M GIBSON DDS (PRESIDENT)
(615) 480-6800
Entity
Organization
Contact information
Practice address
2440 EDENCREST DR, ANTIOCH, TN 37013-1919
(615) 480-6800
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-3911
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
44D2016339
TN
Other
Enumeration date
01/07/2011
Last updated
01/07/2011
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