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General NPI Number Information
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NPI Number | 1114515087
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Entity Type | Organization
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Legal Business Name | SMOKY MOUNTAIN TONGUE-TIE CENTER PLLC
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Dates
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Enumeration Date | 01/06/2021
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 243 JOULE ST
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City | ALCOA
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State | TN
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Zip | 37701-2421
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Country | US
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Telephone | 865-977-1713
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Fax |
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Provider Business Mailing Address
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Address Line | 243 JOULE ST
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City | ALCOA
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State | TN
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Zip | 37701-2421
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Country | US
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Telephone | 865-977-1713
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. CHASE MALONE
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Credential |
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Telephone | 615-423-1828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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