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General NPI Number Information
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NPI Number | 1144844879
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Entity Type | Organization
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Legal Business Name | DANDRIDGE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 05/28/2020
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | 117 E PRICE RD
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City | DANDRIDGE
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State | TN
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Zip | 37725-4513
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Country | US
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Telephone | 865-940-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 117 E PRICE RD
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City | DANDRIDGE
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State | TN
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Zip | 37725-4513
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Country | US
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Telephone | 865-940-1280
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/CO-OWNER
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Name | DR. VICTORIA P CHILDERS
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Credential | MD
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Telephone | 865-940-1280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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