Provider Demographics
NPI:1114059045
Name:FAIN, WALTER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:D
Last Name:FAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 KINGSTON PIKE
Mailing Address - Street 2:STE 185
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3333
Mailing Address - Country:US
Mailing Address - Phone:865-524-4697
Mailing Address - Fax:865-524-4053
Practice Address - Street 1:2607 KINGSTON PIKE
Practice Address - Street 2:STE 185
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3333
Practice Address - Country:US
Practice Address - Phone:865-524-4697
Practice Address - Fax:865-524-4053
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS21801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice