Provider Demographics
NPI:1104410497
Name:HERMITAGE COSMETIC AND IMPLANT DENTISTRY MARK H WHITEFIELD DDS GEN PTR
Entity type:Organization
Organization Name:HERMITAGE COSMETIC AND IMPLANT DENTISTRY MARK H WHITEFIELD DDS GEN PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-889-5545
Mailing Address - Street 1:4251 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1206
Mailing Address - Country:US
Mailing Address - Phone:615-889-8420
Mailing Address - Fax:
Practice Address - Street 1:4251 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1206
Practice Address - Country:US
Practice Address - Phone:615-889-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty