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General NPI Number Information
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NPI Number | 1437557378
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY PC
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 1516 COLEMAN RD SUITE 201
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City | KNOXVILLE
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State | TN
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Zip | 37909-3809
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Country | US
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Telephone | 865-558-8857
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Fax | 865-558-0291
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Provider Business Mailing Address
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Address Line | 1516 COLEMAN RD SUITE 201
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City | KNOXVILLE
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State | TN
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Zip | 37909-3809
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Country | US
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Telephone | 865-558-8857
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Fax | 865-558-0291
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DR. MICHAEL JAMES KOCH
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Credential | DC
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Telephone | 865-558-8857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3722
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 9902
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License Number State | TN
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