Organization
STATE OF TENNESSEE
Active
Other names
Robertson County Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNETTE HALEY (REGIONAL DIRECTOR)
(615) 650-7000
Entity
Organization
Contact information
Practice address
806 SOUTH BROWN STREET, SPRINGFIELD, TN 37172
(615) 384-4504
(615) 384-2067
Mailing address
806 SOUTH BROWN STREET, SPRINGFIELD, TN 37172
(615) 384-4504
(615) 384-2067
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4448020
—
TN
Enumeration date
09/09/2010
Last updated
08/28/2012
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