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General NPI Number Information
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NPI Number | 1184173494
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Entity Type | Organization
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Legal Business Name | 365 DENTISTRY PLLC
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Dates
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Enumeration Date | 09/27/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 5303 JACKSBORO PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37918-3328
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Country | US
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Telephone | 865-336-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 5303 JACKSBORO PIKE
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City | KNOXVILLE
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State | TN
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Zip | 37918-3328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAIRAV KAMLESH VYAS
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Credential | DDS
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Telephone | 865-336-6868
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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 | 9865
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License Number State | TN
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