South Grove Dental

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SOUTH GROVE DENTAL

Practice address

6690 Nolensville Rd Ste 104
Brentwood, TN 37027-8803

Phone

(615) 768-3251

Fax

(615) 241-3009

NPI assigned

Jul 25, 2014

Organization subpart

No

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

Authorized official

Name

Mary Pu

Title

VP of Finance

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1699183327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 734753",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753734753",
            "telephone_number": "615-768-3251",
            "fax_number": "615-241-3009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6690 NOLENSVILLE RD STE 104",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278803",
            "telephone_number": "615-768-3251",
            "fax_number": "615-241-3009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GROVE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-25",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "PU",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Brentwood, TN
• Providers in Brentwood, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.