Provider Demographics
NPI:1447536776
Name:ORTHODONTIC CARE OF TN, PC
Entity type:Organization
Organization Name:ORTHODONTIC CARE OF TN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-355-5822
Mailing Address - Street 1:98 MAYFIELD DR STE D
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3035
Mailing Address - Country:US
Mailing Address - Phone:615-355-5822
Mailing Address - Fax:615-355-5899
Practice Address - Street 1:98 MAYFIELD DR STE D
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3035
Practice Address - Country:US
Practice Address - Phone:615-355-5822
Practice Address - Fax:615-355-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN89511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty