Provider Demographics
NPI:1447668546
Name:HEARTLAND DENTAL CARE OF TN, PC
Entity type:Organization
Organization Name:HEARTLAND DENTAL CARE OF TN, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CRED SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-754-2295
Mailing Address - Street 1:545 N MOUNT JULIET RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4416
Mailing Address - Country:US
Mailing Address - Phone:615-773-0412
Mailing Address - Fax:
Practice Address - Street 1:545 N MOUNT JULIET RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4416
Practice Address - Country:US
Practice Address - Phone:615-773-0412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEARTLAND DENTAL CARE OF TN, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty