Provider Demographics
NPI:1235769241
Name:FARRAGUT DENTAL STUDIO PLLC
Entity Type:Organization
Organization Name:FARRAGUT DENTAL STUDIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAIRAV
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-288-0416
Mailing Address - Street 1:11201 W POINT DR STE 101
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2834
Mailing Address - Country:US
Mailing Address - Phone:865-288-0416
Mailing Address - Fax:865-288-7177
Practice Address - Street 1:11201 W POINT DR STE 101
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2834
Practice Address - Country:US
Practice Address - Phone:865-288-0416
Practice Address - Fax:865-288-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery