Provider Demographics
NPI:1699943001
Name:ASSOCIATED DENTAL GROUP
Entity type:Organization
Organization Name:ASSOCIATED DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-320-1805
Mailing Address - Street 1:1900 PATTERSON ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2119
Mailing Address - Country:US
Mailing Address - Phone:615-320-1805
Mailing Address - Fax:615-320-1546
Practice Address - Street 1:1900 PATTERSON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2119
Practice Address - Country:US
Practice Address - Phone:615-320-1805
Practice Address - Fax:615-320-1546
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty