Healthcare Provider Details

I. General information

NPI: 1588682074
Provider Name (Legal Business Name): JAMES DAVID ERPENBACH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 KINGSTON PIKE SUITE 2E
KNOXVILLE TN
37919
US

IV. Provider business mailing address

6311 KINGSTON PIKE SUITE 2E
KNOXVILLE TN
37919
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-8630
  • Fax: 865-584-6950
Mailing address:
  • Phone: 865-584-8630
  • Fax: 865-584-6950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS3969
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: