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General NPI Number Information
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NPI Number | 1538880711
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Entity Type | Organization
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Legal Business Name | TENNESSEE DENTAL PROFESSIONALS, PC
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 11125 PARKSIDE DR
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City | KNOXVILLE
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State | TN
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Zip | 37934-1961
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Country | US
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Telephone | 865-233-6780
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Fax | 865-233-6214
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Provider Business Mailing Address
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Address Line | 11125 PARKSIDE DR
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City | KNOXVILLE
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State | TN
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Zip | 37934-1961
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Country | US
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Telephone | 865-233-6780
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Fax | 865-233-6214
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | BELINDA HUERTA
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Credential |
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Telephone | 217-540-2100
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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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