Healthcare Provider Details

I. General information

NPI: 1457415697
Provider Name (Legal Business Name): SEYMOUR IMPLANT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PEACOCK CT
SEYMOUR TN
37865
US

IV. Provider business mailing address

111 PEACOCK CT
SEYMOUR TN
37865
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-0194
  • Fax: 865-577-0174
Mailing address:
  • Phone: 865-577-0194
  • Fax: 865-577-0174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. BECKY M JENKINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 865-577-0194