Healthcare Provider Details

I. General information

NPI: 1407959075
Provider Name (Legal Business Name): JACK TOWLER BAUGUSS DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 KINGSTON PIKE 6W
KNOXVILLE TN
37919
US

IV. Provider business mailing address

6311 KINGSTON PIKE 6W
KNOXVILLE TN
37919
US

V. Phone/Fax

Practice location:
  • Phone: 865-588-5778
  • Fax: 865-588-5780
Mailing address:
  • Phone: 865-588-5778
  • Fax: 865-588-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS0000001094
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: