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General NPI Number Information
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NPI Number | 1235468760
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Entity Type | Organization
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Legal Business Name | TENNESSEE VALLEY DENTAL
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Dates
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Enumeration Date | 12/11/2009
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 10641 DEERBROOK DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-1978
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Country | US
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Telephone | 865-671-1255
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Fax |
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Provider Business Mailing Address
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Address Line | 10641 DEERBROOK DR
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City | KNOXVILLE
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State | TN
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Zip | 37922-1978
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Country | US
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Telephone | 865-671-1255
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JOSHUA LYNN EADES
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Credential | DMD
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Telephone | 865-671-1255
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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 | 8200
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License Number State | TN
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