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General NPI Number Information
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NPI Number | 1518407766
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Entity Type | Organization
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Legal Business Name | BEAVER CREEK DENTAL PLLC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 7652 OAK RIDGE HWY
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City | KNOXVILLE
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State | TN
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Zip | 37931-3335
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Country | US
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Telephone | 865-896-3065
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Fax |
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Provider Business Mailing Address
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Address Line | 7652 OAK RIDGE HWY
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City | KNOXVILLE
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State | TN
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Zip | 37931-3335
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Country | US
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Telephone | 865-896-3065
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. KYLE ROBERT SMITH
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Credential | DDS
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Telephone | 865-256-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 10067
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License Number State | TN
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