Healthcare Provider Details

I. General information

NPI: 1629088752
Provider Name (Legal Business Name): TODD EDWARD PILLION D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BLOUNTVILLE HWY STE 202
BRISTOL TN
37620-1671
US

IV. Provider business mailing address

350 BLOUNTVILLE HWY STE 202
BRISTOL TN
37620-1671
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-9661
  • Fax: 423-968-1593
Mailing address:
  • Phone: 423-968-9661
  • Fax: 423-968-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS8560
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: