Provider Demographics
NPI:1215926001
Name:TWIN LAKES DENTAL ASSOCIATES
Entity type:Organization
Organization Name:TWIN LAKES DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-642-2244
Mailing Address - Street 1:405 TYSON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4821
Mailing Address - Country:US
Mailing Address - Phone:731-642-2244
Mailing Address - Fax:731-644-9532
Practice Address - Street 1:405 TYSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4821
Practice Address - Country:US
Practice Address - Phone:731-642-2244
Practice Address - Fax:731-644-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS39281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty