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General NPI Number Information
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NPI Number | 1568952505
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Entity Type | Organization
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Legal Business Name | EAST TENNESSEE PEDIATRIC DENTISTRY AT OAK RIDGEPLLC.
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 500 OAK RIDGE TPKE
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City | OAK RIDGE
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State | TN
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Zip | 37830-7109
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Country | US
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Telephone | 865-859-0357
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Fax | 865-859-0247
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Provider Business Mailing Address
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Address Line | 500 OAK RIDGE TPKE
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City | OAK RIDGE
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State | TN
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Zip | 37830-7109
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSICA PHILLIPS
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Credential | DMD
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Telephone | 865-859-0355
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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 | 9446
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License Number State | TN
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