=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679071989
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHOTO FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2018
-----------------------------------------------------
Last Update Date | 02/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1626 CHOTO MARKETS WAY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-5760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-269-6688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 CREST RD
-----------------------------------------------------
City | MARYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37804-4305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-982-1700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TOMMY SPEARS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 865-388-6323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------