615 Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

615 DENTAL

Doing business as

Blackman Grove Dental

Practice address

4183 Franklin Rd
Suite B5
Murfreesboro, TN 37128-4254

Phone

(615) 907-4746

Fax

(615) 907-4796

NPI assigned

Dec 10, 2015

Last updated

Dec 10, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shawn Foster

Title

Practice Administrator

Phone

(615) 907-4746

Specialties & licenses 1

Addresses

Other names 1

• Blackman Grove Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1043685456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4183 FRANKLIN RD",
            "address_2": "SUITE B5",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371284254",
            "telephone_number": "615-907-4746",
            "fax_number": "615-907-4796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4183 FRANKLIN RD",
            "address_2": "SUITE B5",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371284254",
            "telephone_number": "615-907-4746",
            "fax_number": "615-907-4796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "615 DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-10",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "615-907-4746"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackman Grove Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.