Provider Demographics
NPI:1235468760
Name:TENNESSEE VALLEY DENTAL
Entity Type:Organization
Organization Name:TENNESSEE VALLEY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:EADES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-671-1255
Mailing Address - Street 1:10641 DEERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1978
Mailing Address - Country:US
Mailing Address - Phone:865-671-1255
Mailing Address - Fax:
Practice Address - Street 1:10641 DEERBROOK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1978
Practice Address - Country:US
Practice Address - Phone:865-671-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental