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NPI Code Detail

MEDICARE: CANESA DERAE DENT

MEDICARE: CANESA DERAE DENT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1376K00000XNurse's Aide

General Provider Information

NPI Number : 1225902794
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANESA DERAE DENT
Provider Business Mailing Address
First Line : 1923 SULPHUR SPRINGS RD
Second Line :
City : MORRISTOWN
State : TN
Zip : 37813-5654
Country : US
Telephone Number : 423-317-9344
Fax Number : 423-714-2355
Provider Business Practice Location Address
First Line : 5500 CREEKWOOD PARK BLVD
Second Line :
City : LENOIR CITY
State : TN
Zip : 37772-1200
Country : US
Telephone Number : 865-986-8082
Fax Number : 865-986-5890
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2025
Last Update Date : 09/30/2025

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Directions to “ CANESA DERAE DENT ” Practice Location

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