Healthcare Provider Details

I. General information

NPI: 1700979010
Provider Name (Legal Business Name): JAY SHERWOOD DESVAUX DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 KINGSTON PIKE STE 27W
KNOXVILLE TN
37919
US

IV. Provider business mailing address

2015 LYONS RIDGE RD
KNOXVILLE TN
37919
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-7862
  • Fax: 865-558-6849
Mailing address:
  • Phone: 865-584-3491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS3356
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: