Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0000001742 | TN |
NPI | 1063495372 |
---|---|
Provider Name | Dr. John M. Dedmon |
First Address | Mt.juliet, TN 37112 |
Second Address | Carthage, TN 37030-1429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2005 |
Last Update Date | 08/07/2007 |