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NPI 1629767793ActiveOrganization· Dentist, General Practice· Hermitage, TN
Dentist, General Practice in Hermitage, Tennessee, registered in NPPES in May 2023. The authorized official on file is Tanyika Wan, Vp Administrative Services. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1629767793 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | May 4, 2023 |
| Last updated in NPPES | Apr 30, 2025 |
| Certified by provider | Apr 30, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TN) |
|---|
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