1619361441 NPI number — PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLET TENNESSEE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619361441 NPI number — PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLET TENNESSEE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLET TENNESSEE, PLLC
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:
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:
1619361441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1177 OLD HICKORY BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-988-2603
Provider Business Mailing Address Fax Number:
615-988-2661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1177 OLD HICKORY BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-4241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-988-2603
Provider Business Practice Location Address Fax Number:
615-988-2661
Provider Enumeration Date:
03/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MEISTER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
615-988-2603

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com