Provider Demographics
NPI:1164664140
Name:PICKETT, DAVID O (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:PICKETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:248 N PETERS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4925
Mailing Address - Country:US
Mailing Address - Phone:865-691-0918
Mailing Address - Fax:865-691-6215
Practice Address - Street 1:248 N PETERS RD
Practice Address - Street 2:STE 3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4925
Practice Address - Country:US
Practice Address - Phone:865-691-0918
Practice Address - Fax:865-691-6215
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9474204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery