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General NPI Number Information
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NPI Number | 1366917585
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Entity Type | Organization
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Legal Business Name | LAKEVIEW DENTAL ARTS
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 1011 WATERFORD PL
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City | KINGSTON
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State | TN
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Zip | 37763-2686
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Country | US
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Telephone | 865-376-9687
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Fax |
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Provider Business Mailing Address
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Address Line | 1011 WATERFORD PL
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City | KINGSTON
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State | TN
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Zip | 37763-2686
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Country | US
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Telephone | 865-376-9687
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES WALMSLEY
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Credential |
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Telephone | 865-376-9687
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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 |
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License Number State |
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