Provider Demographics
NPI:1306570619
Name:VIBE DENTAL OF ANTIOCH PLLC
Entity type:Organization
Organization Name:VIBE DENTAL OF ANTIOCH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:931-363-1388
Mailing Address - Street 1:317 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-3842
Mailing Address - Country:US
Mailing Address - Phone:615-512-1839
Mailing Address - Fax:
Practice Address - Street 1:5357 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2308
Practice Address - Country:US
Practice Address - Phone:615-731-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty