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General NPI Number Information
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NPI Number | 1780091132
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Entity Type | Individual
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Provider Name | WILLIAM ANDREW MALLARD D.D.S
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Gender | Male
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 11201 W POINT DR STE 100
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City | KNOXVILLE
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State | TN
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Zip | 37934-2833
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Country | US
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Telephone | 865-309-4020
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Fax |
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Provider Business Mailing Address
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Address Line | 6821 HAVERHILL DR
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City | KNOXVILLE
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State | TN
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Zip | 37909-2612
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Country | US
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Telephone | 731-445-4007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4003
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10487
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License Number State | TN
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