Provider Demographics
NPI:1184847329
Name:BRISTOL PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:BRISTOL PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PILLION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-968-9661
Mailing Address - Street 1:350 BLOUNTVILLE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-0213
Mailing Address - Country:US
Mailing Address - Phone:423-968-9661
Mailing Address - Fax:423-968-1593
Practice Address - Street 1:350 BLOUNTVILLE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-0213
Practice Address - Country:US
Practice Address - Phone:423-968-9661
Practice Address - Fax:423-968-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS85601223P0221X
TNDS24671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty