MEDICARE: KPM DENTAL PARTNERS PLLC

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	:	1518525377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KPM DENTAL PARTNERS PLLC

Provider Business Mailing Address
First Line	:	121 S WEISGARBER RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-4955
Country	:	US
Telephone Number	:	865-588-5749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4141 RINGGOLD RD
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37412-2465
Country	:	US
Telephone Number	:	423-622-5165
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MARY BETH FITZPATRICK
Credential	:
Telephone Number	:	865-588-5749

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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