=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013601681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONICA T GINART DMD MS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2023
-----------------------------------------------------
Last Update Date | 06/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2014 W BROADWAY AVE
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37801-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-724-0505
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1213 HAMSTEAD CT
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-6081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-505-3470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MONICA T GINART
-----------------------------------------------------
Credential | DMD, MS
-----------------------------------------------------
Telephone | 305-505-3470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------