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General NPI Number Information
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NPI Number | 1164189486
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Entity Type | Organization
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Legal Business Name | TW NEW DENTISTRY, PLLC
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 7828 KINGSTON PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37919-5520
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Country | US
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Telephone | 865-693-8131
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BURTON HILLS BLVD STE 400
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City | NASHVILLE
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State | TN
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Zip | 37215-3004
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Country | US
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Telephone | 615-479-2196
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RYAN MCCOSTLIN
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Credential |
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Telephone | 615-479-2196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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