Healthcare Provider Details

I. General information

NPI: 1699283432
Provider Name (Legal Business Name): PEDIATRIC DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 E EMORY RD STE 101
POWELL TN
37849-4016
US

IV. Provider business mailing address

209 E EMORY RD STE 101
POWELL TN
37849-4016
US

V. Phone/Fax

Practice location:
  • Phone: 865-558-8857
  • Fax: 865-558-8857
Mailing address:
  • Phone: 865-558-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1902
License Number StateTN

VIII. Authorized Official

Name: DR. VALERIE A ESKER
Title or Position: OWNER/PEDIATRIC DENTIST
Credential: DMD
Phone: 865-558-8857