Provider Demographics
NPI:1104492008
Name:TENNESSEE FAMILY DENTAL BELLEVUE PC
Entity type:Organization
Organization Name:TENNESSEE FAMILY DENTAL BELLEVUE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-388-5832
Mailing Address - Street 1:4025 W MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-3726
Mailing Address - Country:US
Mailing Address - Phone:269-388-5832
Mailing Address - Fax:616-469-1036
Practice Address - Street 1:917 HARPETH VALLEY PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-1141
Practice Address - Country:US
Practice Address - Phone:615-646-5151
Practice Address - Fax:616-469-1036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental