Provider Demographics
NPI:1689116394
Name:OLD HICKORY FAMILY DENTISTRY
Entity type:Organization
Organization Name:OLD HICKORY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLASMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-758-9117
Mailing Address - Street 1:101 MATTERHORN DR
Mailing Address - Street 2:
Mailing Address - City:OLD HICKORY
Mailing Address - State:TN
Mailing Address - Zip Code:37138-1573
Mailing Address - Country:US
Mailing Address - Phone:615-758-9117
Mailing Address - Fax:
Practice Address - Street 1:101 MATTERHORN DR
Practice Address - Street 2:
Practice Address - City:OLD HICKORY
Practice Address - State:TN
Practice Address - Zip Code:37138-1573
Practice Address - Country:US
Practice Address - Phone:615-758-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental