Organization
STATE OF TENNESSEE
Active
Other names
MCRO Mobile Dental Unit
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE HALEY (REGIONAL DIRECTOR)
(615) 650-7000
Entity
Organization
Contact information
Practice address
710 HART LN, NASHVILLE, TN 37216-2627
(615) 650-7000
(615) 262-6139
Mailing address
710 HART LN, NASHVILLE, TN 37216-2627
(615) 650-7000
(615) 262-6139
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014540
DORAL DENTAL LOCATION ID
TN
05
—
4447844
—
TN
Enumeration date
01/31/2007
Last updated
08/28/2012
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