Healthcare Provider Details

I. General information

NPI: 1659996320
Provider Name (Legal Business Name): PICKERING & ALLEN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4741 N BROADWAY ST
KNOXVILLE TN
37918-1793
US

IV. Provider business mailing address

4741 N BROADWAY ST STE C
KNOXVILLE TN
37918-1793
US

V. Phone/Fax

Practice location:
  • Phone: 865-687-9412
  • Fax: 865-688-0656
Mailing address:
  • Phone: 865-687-9412
  • Fax: 865-688-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERRI A. HANCOCK
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 865-687-9412