Healthcare Provider Details

I. General information

NPI: 1992217400
Provider Name (Legal Business Name): JAY S. DESVAUX, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 KINGSTON PIKE #27W
KNOXVILLE TN
37919
US

IV. Provider business mailing address

6311 KINGSTON PIKE #27W
KNOXVILLE TN
37919
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JAY S. DESVAUX
Title or Position: OWNER/DDS
Credential: D.D.S.
Phone: 865-588-7862