Provider Demographics
NPI:1396142485
Name:THE ESTATE OF P. LARAY RECTOR
Entity type:Organization
Organization Name:THE ESTATE OF P. LARAY RECTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROSSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-359-1900
Mailing Address - Street 1:553 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-3219
Mailing Address - Country:US
Mailing Address - Phone:931-359-1900
Mailing Address - Fax:931-359-9774
Practice Address - Street 1:553 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091
Practice Address - Country:US
Practice Address - Phone:931-359-1900
Practice Address - Fax:931-359-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty