Individual
DR. MARISSA SANDIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1100 NEAL ST STE B, COOKEVILLE, TN 38501-0900
(931) 240-6224
Mailing address
1809 MCEWEN AVE, NASHVILLE, TN 37206-1856
(770) 633-6566
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901021436
MI
1223P0221X
Pediatric Dentistry
Primary
10377
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q026169
—
TN
Enumeration date
01/12/2015
Last updated
01/01/2019
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