Healthcare Provider Details

I. General information

NPI: 1538166939
Provider Name (Legal Business Name): DIMITRIOS J VARELDZIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CENTER PARK DR STE 900
KNOXVILLE TN
37922-2176
US

IV. Provider business mailing address

215 CENTER PARK DR STE 900
KNOXVILLE TN
37922-2176
US

V. Phone/Fax

Practice location:
  • Phone: 865-966-0500
  • Fax:
Mailing address:
  • Phone: 865-966-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS0000011708
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6471
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: