Healthcare Provider Details

I. General information

NPI: 1578262820
Provider Name (Legal Business Name): SVETLANA PUCHALSKY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CAPITAL DR
KNOXVILLE TN
37922-3393
US

IV. Provider business mailing address

33 RIVERSIDE DR
OAK RIDGE TN
37830-9001
US

V. Phone/Fax

Practice location:
  • Phone: 865-670-7477
  • Fax:
Mailing address:
  • Phone: 865-771-7277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number10033
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: