MEDICARE: DR. ALEXANDER WAYNE PILGREEN DDS

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
1	1223G0001X	General Practice Dentistry	10540	TN

General Provider Information

NPI Number	:	1326576786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER WAYNE PILGREEN DDS

Provider Business Mailing Address
First Line	:	613 WATAUGA ST
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-4429
Country	:	US
Telephone Number	:	423-245-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2319 VOLUNTEER PKWY
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-6701
Country	:	US
Telephone Number	:	423-573-7741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	05/30/2017

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