Healthcare Provider Details

I. General information

NPI: 1447418736
Provider Name (Legal Business Name): KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 GATE LANE SUITE 101
KNOXVILLE TN
37909
US

IV. Provider business mailing address

705 GATE LANE SUITE 101
KNOXVILLE TN
37909
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-5437
  • Fax: 865-588-1862
Mailing address:
  • Phone: 865-522-5437
  • Fax: 865-588-1862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8900
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8203
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9607
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2060
License Number StateTN

VIII. Authorized Official

Name: DR. JOSEPH REED TOWNSEND
Title or Position: DENTIST/OWNER
Credential: D.D.S.
Phone: 865-522-5437