Healthcare Provider Details

I. General information

NPI: 1407156300
Provider Name (Legal Business Name): CHILDREN'S DENTISTRY OF KNOXVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 FOX RD SUITE 100
KNOXVILLE TN
37922-3578
US

IV. Provider business mailing address

323 FOX RD SUITE 100
KNOXVILLE TN
37922-3578
US

V. Phone/Fax

Practice location:
  • Phone: 865-357-5560
  • Fax: 865-357-5562
Mailing address:
  • Phone: 865-357-5560
  • Fax: 865-357-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8478
License Number StateTN

VIII. Authorized Official

Name: DR. DARRYL EDWARD PHILLIPS
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 865-357-5560