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General NPI Number Information
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NPI Number | 1831887553
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTAL PARTNERS
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 10238 HARDIN VALLEY RD
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City | KNOXVILLE
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State | TN
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Zip | 37932-1609
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Country | US
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Telephone | 865-229-4969
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Fax |
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Provider Business Mailing Address
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Address Line | 4153 FOREST GLEN DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-5214
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Country | US
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Telephone | 615-374-8951
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MARY ELIZABETH JOHNSON FANCHER
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Credential | DDS, MS
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Telephone | 865-229-4969
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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 |
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License Number State |
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