Healthcare Provider Details

I. General information

NPI: 1851396667
Provider Name (Legal Business Name): ROBERT CRAIG CAIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 CASTAIC LN
KNOXVILLE TN
37932-1557
US

IV. Provider business mailing address

2040 CASTAIC LN
KNOXVILLE TN
37932-1557
US

V. Phone/Fax

Practice location:
  • Phone: 865-246-0460
  • Fax: 865-482-0592
Mailing address:
  • Phone: 865-246-0460
  • Fax: 865-482-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS7208
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: