Provider Demographics
NPI:1275696312
Name:POZEGA, STANLEY M (DDS)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:M
Last Name:POZEGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5034 NORTH BROADWAY STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918
Mailing Address - Country:US
Mailing Address - Phone:865-689-5850
Mailing Address - Fax:865-689-9930
Practice Address - Street 1:5034 NORTH BROADWAY STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918
Practice Address - Country:US
Practice Address - Phone:865-689-5850
Practice Address - Fax:865-689-9930
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND5187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist