Healthcare Provider Details

I. General information

NPI: 1558709204
Provider Name (Legal Business Name): NATHAN CHARLES LA MONICA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 KNOXVILLE CENTER DR SUITE #1100
KNOXVILLE TN
37924-5044
US

IV. Provider business mailing address

3001 KNOXVILLE CENTER DR SUITE #1100
KNOXVILLE TN
37924-5044
US

V. Phone/Fax

Practice location:
  • Phone: 865-544-1711
  • Fax:
Mailing address:
  • Phone: 865-544-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10031
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: