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General NPI Number Information
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NPI Number | 1275355059
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Entity Type | Organization
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Legal Business Name | SCENIC CITY SMILES PLLC
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 4300 PEERLESS RD NW STE 100
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City | CLEVELAND
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State | TN
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Zip | 37312-3730
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Country | US
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Telephone | 423-855-4201
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Fax | 423-855-4203
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Provider Business Mailing Address
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Address Line | 4300 PEERLESS RD NW STE 100
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City | CLEVELAND
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State | TN
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Zip | 37312-3730
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Country | US
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Telephone | 423-855-4201
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Fax | 423-855-4203
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | TATHIA MATTILA
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Credential |
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Telephone | 423-314-7529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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