Healthcare Provider Details

I. General information

NPI: 1275355059
Provider Name (Legal Business Name): SCENIC CITY SMILES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PEERLESS RD NW STE 100
CLEVELAND TN
37312-3730
US

IV. Provider business mailing address

4300 PEERLESS RD NW STE 100
CLEVELAND TN
37312-3730
US

V. Phone/Fax

Practice location:
  • Phone: 423-855-4201
  • Fax: 423-855-4203
Mailing address:
  • Phone: 423-855-4201
  • Fax: 423-855-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TATHIA MATTILA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 423-314-7529