Provider Demographics
NPI:1154180073
Name:FESMIRE DENTAL PLLC
Entity type:Organization
Organization Name:FESMIRE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAINOA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WATERHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-865-1733
Mailing Address - Street 1:106 CUDE LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-2202
Mailing Address - Country:US
Mailing Address - Phone:615-598-8660
Mailing Address - Fax:615-860-7585
Practice Address - Street 1:106 CUDE LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-2202
Practice Address - Country:US
Practice Address - Phone:615-598-8660
Practice Address - Fax:615-860-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty