Provider Demographics
NPI:1679543490
Name:SUMNER COUNTY DENTAL
Entity type:Organization
Organization Name:SUMNER COUNTY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNTY DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-451-7200
Mailing Address - Street 1:1005B UNION SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066
Mailing Address - Country:US
Mailing Address - Phone:615-451-7200
Mailing Address - Fax:615-451-3666
Practice Address - Street 1:1005B UNION SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-451-7200
Practice Address - Fax:615-451-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225507Medicaid