Provider Demographics
NPI:1023907151
Name:BLUE DOG FAMILY DENTISTRY
Entity type:Organization
Organization Name:BLUE DOG FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-885-2345
Mailing Address - Street 1:10825 HARDIN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1410
Mailing Address - Country:US
Mailing Address - Phone:865-338-3098
Mailing Address - Fax:865-338-3104
Practice Address - Street 1:10825 HARDIN VALLEY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-1410
Practice Address - Country:US
Practice Address - Phone:865-338-3098
Practice Address - Fax:865-338-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1871143826OtherUNKNOWN