Provider Demographics
NPI:1174952642
Name:PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLE TENNESSEE, PLLC
Entity type:Organization
Organization Name:PERIODONTAL & IMPLANT ASSOCIATES OF MIDDLE TENNESSEE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:PULLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:615-297-8973
Mailing Address - Street 1:4205 HILLSBORO PIKE
Mailing Address - Street 2:STE. 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3381
Mailing Address - Country:US
Mailing Address - Phone:615-297-8973
Mailing Address - Fax:615-297-6603
Practice Address - Street 1:4205 HILLSBORO PIKE
Practice Address - Street 2:STE. 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3381
Practice Address - Country:US
Practice Address - Phone:615-297-8973
Practice Address - Fax:615-297-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0077391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty