Provider Demographics
NPI:1225202898
Name:MOUNTAIN DENTAL P.C.
Entity Type:Organization
Organization Name:MOUNTAIN DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-546-7436
Mailing Address - Street 1:6215 RIVERVIEW CROSSING DR STE C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37924-2839
Mailing Address - Country:US
Mailing Address - Phone:865-546-7436
Mailing Address - Fax:865-546-7259
Practice Address - Street 1:6215 RIVERVIEW CROSSING DR STE C
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-2839
Practice Address - Country:US
Practice Address - Phone:865-546-7436
Practice Address - Fax:865-546-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000004867261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental