Provider Demographics
NPI:1699289702
Name:BMMM, INC
Entity type:Organization
Organization Name:BMMM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:MINIX
Authorized Official - Last Name:HUFFINE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:606-886-0808
Mailing Address - Street 1:709 RIVERBRANCH CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-6599
Mailing Address - Country:US
Mailing Address - Phone:615-336-4148
Mailing Address - Fax:859-813-0824
Practice Address - Street 1:253 HAGER BR
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:KY
Practice Address - Zip Code:41216-8766
Practice Address - Country:US
Practice Address - Phone:606-886-0808
Practice Address - Fax:859-813-0824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BMMM,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6678122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60066784Medicaid