Healthcare Provider Details

I. General information

NPI: 1649879271
Provider Name (Legal Business Name): KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2020
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2944 TAZEWELL PIKE STE 1
KNOXVILLE TN
37918-1990
US

IV. Provider business mailing address

2944 TAZEWELL PIKE STE 1
KNOXVILLE TN
37918-1990
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 TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CEANN GERRITY
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-522-5437