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General Practice Dentist

Pulaski, Tennessee

Provider NPI: 1285623769

Provider Information:
Gender: M

Practice Location:
317 S 2ND ST  PULASKI, TN 38478 US
Tel: 931-363-5417  Fax: 931-363-4695

Business Mailing Address:
317 S 2ND ST  PULASKI, TN 38478 US
Tel: 931-363-5417  Fax: 931-363-4695

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
General Practice

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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