Healthcare Provider Details

I. General information

NPI: 1992660070
Provider Name (Legal Business Name): HEND KISAIBAT BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10792 HARDIN VALLEY RD
KNOXVILLE TN
37932-1407
US

IV. Provider business mailing address

1675 OLD CANTON RD
MARIETTA GA
30062-2619
US

V. Phone/Fax

Practice location:
  • Phone: 865-983-3570
  • Fax:
Mailing address:
  • Phone: 404-667-3780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13019
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: