| Jupiter 4gd, Llc | |
|
110 Winwood Dr Lebanon TN 37087-3134 | |
| (615) 453-8900 | |
| Not Available |
| Full Name | Jupiter 4gd, Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 110 Winwood Dr, Lebanon, Tennessee |
| Authorized Official Name and Position | Michael Jayson Tabor (OWNER) |
| Authorized Official Contact | 6154538900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jupiter 4gd, Llc 110 Winwood Dr Lebanon TN 37087-3134 Ph: (615) 453-8900 | Jupiter 4gd, Llc 110 Winwood Dr Lebanon TN 37087-3134 Ph: (615) 453-8900 |
| NPI Number | 1710679071 |
|---|---|
| Provider Enumeration Date | 05/24/2023 |
| Last Update Date | 07/31/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710679071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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