Provider Demographics
NPI:1306868260
Name:KNOXVILLE DENTAL GROUP PC
Entity Type:Organization
Organization Name:KNOXVILLE DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:PIGFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-671-0603
Mailing Address - Street 1:10652 DEERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1941
Mailing Address - Country:US
Mailing Address - Phone:865-671-0603
Mailing Address - Fax:865-671-0604
Practice Address - Street 1:10652 DEERBROOK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1941
Practice Address - Country:US
Practice Address - Phone:865-671-0603
Practice Address - Fax:865-671-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty