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General NPI Number Information
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NPI Number | 1457591190
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Entity Type | Organization
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Legal Business Name | ASSOCIATED DENTAL PROFESSIONALS WEST
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 8874 KINGSTON PIKE SUITE 102
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City | KNOXVILLE
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State | TN
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Zip | 37923-5013
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Country | US
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Telephone | 865-691-2330
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Fax | 865-691-2344
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Provider Business Mailing Address
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Address Line | 8874 KINGSTON PIKE, SUITE 102 ASSOCIATED DENTAL PROFESSIONALS WEST
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City | KNOXVILLE
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State | TN
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Zip | 37923-5013
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Country | US
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Telephone | 865-691-2330
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Fax | 865-691-2344
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK T BARKER
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Credential | D.M.D.
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Telephone | 865-691-2330
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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 | DS 5278
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS 3638
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License Number State | TN
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