Healthcare Provider Details

I. General information

NPI: 1235879586
Provider Name (Legal Business Name): CANDY LEEANN BORUFF RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MEDICAL CENTER WAY
KNOXVILLE TN
37920-3257
US

IV. Provider business mailing address

8416 GRACELAND RD
CORRYTON TN
37721-2002
US

V. Phone/Fax

Practice location:
  • Phone: 865-549-5353
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4273
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: