MEDICARE: ASPEN DENTAL

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	9358	TN

General Provider Information

NPI Number	:	1467714584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN DENTAL

Provider Business Mailing Address
First Line	:	PO BOX 3189
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13220-3189
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7731 KINGSTON PIKE
Second Line	:	102
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5519
Country	:	US
Telephone Number	:	865-525-4422
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER RELATIONS MANAGER
Name	:	ASHLEY COLE
Credential	:
Telephone Number	:	315-454-6000

Provider Enumeration Date	:	06/14/2012
Last Update Date	:	06/14/2012

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Directions to “ASPEN DENTAL ” Practice Location

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