Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 27028 | TN |
NPI | 1003811696 |
---|---|
Provider Name | Mark Dentz |
First Address | Nashville, TN 37203-1448 |
Second Address | Nashville, TN 37203-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 20/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009930405 | (05) | AL |
3065032 | BCBS PROVIDER NUMBER (01) | TN |
3813113 | (05) | TN |
64926249 | (05) | KY |
7613690 | (05) | NC |
F58918 | (02) | TN |