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General NPI Number Information
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NPI Number | 1659965531
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Entity Type | Organization
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Legal Business Name | MARBLE CITY DENTISTRY & FACIAL ESTHETICS
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Dates
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Enumeration Date | 02/22/2021
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 800 S GAY ST STE P325
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City | KNOXVILLE
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State | TN
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Zip | 37929-9749
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Country | US
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Telephone | 865-888-8999
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Fax | 865-200-8000
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Provider Business Mailing Address
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Address Line | 800 S GAY ST STE P325
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City | KNOXVILLE
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State | TN
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Zip | 37929-9749
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Country | US
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Telephone | 865-888-8999
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Fax | 865-200-8000
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MINDY HAZELWOOD
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Credential |
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Telephone | 865-888-8999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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