Healthcare Provider Details

I. General information

NPI: 1417541038
Provider Name (Legal Business Name): WILLIAM JOHN AXTELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 HIGHWAY 49 E STE 101
PLEASANT VIEW TN
37146-7157
US

IV. Provider business mailing address

2516 HIGHWAY 49 E STE 101
PLEASANT VIEW TN
37146-7157
US

V. Phone/Fax

Practice location:
  • Phone: 615-649-4155
  • Fax: 629-300-9751
Mailing address:
  • Phone: 615-649-4155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12128
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: