Organization
TRAILHEAD PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN DAVID SHADBURNE DMD (PEDIATRIC DENTIST)
(270) 218-0708
Entity
Organization
Contact information
Practice address
124 GOODVIEW WAY STE B, GALLATIN, TN 37066-3125
(270) 218-0708
Mailing address
809 DUNBAR CT, GOODLETTSVILLE, TN 37072-1496
(270) 218-0708
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/04/2021
Last updated
10/04/2023
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