Healthcare Provider Details

I. General information

NPI: 1992985865
Provider Name (Legal Business Name): LINCOLN MEMORIAL UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 04/26/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 ST. MARY STREET
KNOXVILLE TN
37917
US

IV. Provider business mailing address

6965 CUMBERLAND GAP PKWY
HARROGATE TN
37752-8231
US

V. Phone/Fax

Practice location:
  • Phone: 865-338-5755
  • Fax:
Mailing address:
  • Phone: 423-869-6229
  • Fax: 423-869-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SABRINA LAYEL
Title or Position: ASSISTANT VICE PRESIDENT, FINANCE
Credential:
Phone: 423-869-6229