Provider Demographics
NPI:1215272521
Name:BRENTWOOD DENTAL EXCELLENCE, PC
Entity type:Organization
Organization Name:BRENTWOOD DENTAL EXCELLENCE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASMA
Authorized Official - Middle Name:FURRUKH
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-373-5914
Mailing Address - Street 1:6 CADILLAC DR
Mailing Address - Street 2:130
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5080
Mailing Address - Country:US
Mailing Address - Phone:615-373-5914
Mailing Address - Fax:
Practice Address - Street 1:6 CADILLAC DR
Practice Address - Street 2:130
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5080
Practice Address - Country:US
Practice Address - Phone:615-373-5914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8169122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty