Provider Demographics
NPI:1376623082
Name:SEYMOUR FAMILY DENTISTRY
Entity Type:Organization
Organization Name:SEYMOUR FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-577-0194
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:111 PEACOCK COURT
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865
Mailing Address - Country:US
Mailing Address - Phone:865-577-0194
Mailing Address - Fax:865-573-6770
Practice Address - Street 1:111 PEACOCK COURT
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865
Practice Address - Country:US
Practice Address - Phone:865-577-0194
Practice Address - Fax:865-573-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty