Provider Demographics
NPI:1366999849
Name:PARADISE DENTAL
Entity type:Organization
Organization Name:PARADISE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BAYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERDOWSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-758-2085
Mailing Address - Street 1:66 EAST HILL STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122
Mailing Address - Country:US
Mailing Address - Phone:615-758-2085
Mailing Address - Fax:615-758-2874
Practice Address - Street 1:66 E HILL DR
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-8031
Practice Address - Country:US
Practice Address - Phone:615-758-2085
Practice Address - Fax:615-758-2874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN99321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty