Healthcare Provider Details

I. General information

NPI: 1124988092
Provider Name (Legal Business Name): WEST KNOXVILLE DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SIMMONS RD STE I
KNOXVILLE TN
37922-1943
US

IV. Provider business mailing address

310 SIMMONS RD STE I
KNOXVILLE TN
37922-1943
US

V. Phone/Fax

Practice location:
  • Phone: 360-513-5328
  • Fax:
Mailing address:
  • Phone: 360-513-5328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEARSTIN STALLINGS
Title or Position: CEO
Credential:
Phone: 770-307-8726