Healthcare Provider Details

I. General information

NPI: 1740271659
Provider Name (Legal Business Name): BRIAN K SCHENCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4845 HIXSON PIKE
HIXSON TN
37343-4466
US

IV. Provider business mailing address

PO BOX 1446
HIXSON TN
37343-4466
US

V. Phone/Fax

Practice location:
  • Phone: 423-875-4812
  • Fax: 423-875-4814
Mailing address:
  • Phone: 423-875-4812
  • Fax: 423-875-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS7666
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: