Healthcare Provider Details

I. General information

NPI: 1598376808
Provider Name (Legal Business Name): AARON HEBER PACK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 EMORY VALLEY RD STE A
OAK RIDGE TN
37830-7746
US

IV. Provider business mailing address

1842 PRODUCE LN
JOHNS ISLAND SC
29455-8307
US

V. Phone/Fax

Practice location:
  • Phone: 865-213-5156
  • Fax:
Mailing address:
  • Phone: 801-228-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13058
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.10447.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: