Healthcare Provider Details

I. General information

NPI: 1639541543
Provider Name (Legal Business Name): EUGENE STINSON DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 WINFIELD DUNN PKWY SUITE 301
KODAK TN
37764-4306
US

IV. Provider business mailing address

2946 WINFIELD DUNN PKWY SUITE 301
KODAK TN
37764-4306
US

V. Phone/Fax

Practice location:
  • Phone: 865-465-7058
  • Fax: 865-465-3432
Mailing address:
  • Phone: 865-465-7058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS0000003957
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS0000005043
License Number StateTN

VIII. Authorized Official

Name: KAY HARRISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-465-7058