Organization
PEDIATRIC DENTISTRY OF CHATTANOOGA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOMMER NICOLE MAYNOR (CREDENTIALING MGR)
(423) 541-5427
Entity
Organization
Contact information
Practice address
150 STUART CROSSING, CLEVELAND, TN 37312-4065
(423) 541-5500
(423) 476-2680
Mailing address
P.O. BOX 4078, CLEVELAND, TN 37320-4078
(423) 541-5500
(423) 476-2680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
07/02/2012
Last updated
05/06/2024
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