Provider Demographics
NPI:1275232225
Name:CARSON, TONYA LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:LYNN
Last Name:CARSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NELSON LN
Mailing Address - Street 2:
Mailing Address - City:PIONEER
Mailing Address - State:TN
Mailing Address - Zip Code:37847-2738
Mailing Address - Country:US
Mailing Address - Phone:423-215-3999
Mailing Address - Fax:
Practice Address - Street 1:801 W OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-2747
Practice Address - Country:US
Practice Address - Phone:865-522-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH4763124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist