Healthcare Provider Details

I. General information

NPI: 1952954281
Provider Name (Legal Business Name): FARRAGUT ORAL SURGERY AND IMPLANT CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 ALCOA HWY BLDG B
KNOXVILLE TN
37920-1502
US

IV. Provider business mailing address

7632 GLEASON DR
KNOXVILLE TN
37919-6846
US

V. Phone/Fax

Practice location:
  • Phone: 865-409-0036
  • Fax: 865-223-6313
Mailing address:
  • Phone: 865-409-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA CAMPBELL
Title or Position: OWNER
Credential: DDS
Phone: 865-409-0036