Provider Demographics
NPI:1083975536
Name:BEARDEN PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:BEARDEN PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-851-9347
Mailing Address - Street 1:601 CONCORD ST
Mailing Address - Street 2:SUITE 102-104
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3307
Mailing Address - Country:US
Mailing Address - Phone:865-851-9347
Mailing Address - Fax:865-851-7849
Practice Address - Street 1:601 CONCORD ST
Practice Address - Street 2:SUITE 102-104
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3307
Practice Address - Country:US
Practice Address - Phone:865-851-9347
Practice Address - Fax:865-851-7849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS87021223P0221X, 284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No284300000XHospitalsSpecial HospitalGroup - Single Specialty