MEDICARE: KNOXVILLE DENTAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1427792357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KNOXVILLE DENTAL, PC

Provider Business Mailing Address
First Line	:	1547 DOWNTOWN WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5407
Country	:	US
Telephone Number	:	865-247-5570
Fax Number	:	865-247-5053

Provider Business Practice Location Address
First Line	:	1547 DOWNTOWN WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5407
Country	:	US
Telephone Number	:	865-247-5570
Fax Number	:	865-247-5053

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. TERRIE LIANE CRIBBS
Credential	:	DDS
Telephone Number	:	865-247-5570

Provider Enumeration Date	:	04/26/2022
Last Update Date	:	04/26/2022

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