Provider Demographics
NPI:1447034392
Name:MT. JULIET DENTAL STUDIO PLLC
Entity type:Organization
Organization Name:MT. JULIET DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SKYLOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-970-2300
Mailing Address - Street 1:20 OLD PLEASANT GROVE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3880
Mailing Address - Country:US
Mailing Address - Phone:615-970-2300
Mailing Address - Fax:
Practice Address - Street 1:20 OLD PLEASANT GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3880
Practice Address - Country:US
Practice Address - Phone:615-970-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty