Healthcare Provider Details

I. General information

NPI: 1558097857
Provider Name (Legal Business Name): EAST TENNESSEE FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E DIVISION RD STE 6
OAK RIDGE TN
37830-6908
US

IV. Provider business mailing address

6311 KINGSTON PIKE STE 8W
KNOXVILLE TN
37919-4906
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-1701
  • Fax: 865-482-6176
Mailing address:
  • Phone: 865-584-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: AMBER LAWSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-584-8630