Provider Demographics
NPI:1063585404
Name:OP DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:OP DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:POLK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:615-333-2833
Mailing Address - Street 1:4718 NOLENSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5408
Mailing Address - Country:US
Mailing Address - Phone:615-333-2833
Mailing Address - Fax:615-333-2863
Practice Address - Street 1:4718 NOLENSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5408
Practice Address - Country:US
Practice Address - Phone:615-333-2833
Practice Address - Fax:615-333-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS38421223P0221X
TNDS37291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9178327Medicaid
TN9177774OtherTN CARE