Organization
SOUTH GROVE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY PU (VP OF FINANCE)
(972) 869-3789
Entity
Organization
Contact information
Practice address
6690 NOLENSVILLE RD STE 104, BRENTWOOD, TN 37027-8803
(615) 768-3251
(615) 241-3009
Mailing address
PO BOX 734753, DALLAS, TX 75373-4753
(615) 768-3251
(615) 241-3009
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
07/25/2014
Last updated
07/17/2023
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