Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 10423 | TN |
NPI | 1104286566 |
---|---|
Provider Name | Dr. Colton Popp |
First Address | Chattanooga, TN 37415-3113 |
Second Address | Chattanooga, TN 37415-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2016 |
Last Update Date | 12/09/2018 |