MEDICARE: DR. PABLO FONCEA D.M.D.

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	D57813TN	TN

General Provider Information

NPI Number	:	1891708863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PABLO FONCEA D.M.D.

Provider Business Mailing Address
First Line	:	2719 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-4620
Country	:	US
Telephone Number	:	865-973-9899
Fax Number	:	865-524-0194

Provider Business Practice Location Address
First Line	:	2719 KINGSTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-4620
Country	:	US
Telephone Number	:	865-973-9899
Fax Number	:	865-524-0194

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	09/08/2020

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