Provider Demographics
NPI:1487082434
Name:ABSOLUTE PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:ABSOLUTE PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOCTORA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-455-8255
Mailing Address - Street 1:1956 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2204
Mailing Address - Country:US
Mailing Address - Phone:931-455-8255
Mailing Address - Fax:931-563-5566
Practice Address - Street 1:1956 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2204
Practice Address - Country:US
Practice Address - Phone:931-455-8255
Practice Address - Fax:931-563-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty