1205008497 NPI number — KAIL, GROBMYER AND LEONARD DENTISTRY

Table of content: CHERYL A. LITTLE LPTA (NPI 1962660670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205008497 NPI number — KAIL, GROBMYER AND LEONARD DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAIL, GROBMYER AND LEONARD DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205008497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6058 HIGHWAY 412 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38006-3908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-663-9999
Provider Business Mailing Address Fax Number:
731-663-0510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6058 HIGHWAY 412 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38006-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-663-9999
Provider Business Practice Location Address Fax Number:
731-663-0510
Provider Enumeration Date:
03/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE
Authorized Official Telephone Number:
731-663-9999

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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