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General NPI Number Information
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NPI Number | 1336351451
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Entity Type | Organization
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Legal Business Name | CORNERSTONE DENTAL ARTS ASSOC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 8912 TOWN AND COUNTRY CIR
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City | KNOXVILLE
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State | TN
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Zip | 37923-4900
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Country | US
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Telephone | 865-691-0995
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Fax |
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Provider Business Mailing Address
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Address Line | 8912 TOWN AND COUNTRY CIR
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City | KNOXVILLE
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State | TN
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Zip | 37923-4900
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Country | US
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Telephone | 865-691-0995
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | SHEILA BOATMAN
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Credential |
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Telephone | 865-691-0995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS7986
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License Number State | TN
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