Provider Demographics
NPI:1447418736
Name:KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Other - Org Name:KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:REED
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-522-5437
Mailing Address - Street 1:705 GATE LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909
Mailing Address - Country:US
Mailing Address - Phone:865-522-5437
Mailing Address - Fax:865-588-1862
Practice Address - Street 1:705 GATE LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909
Practice Address - Country:US
Practice Address - Phone:865-522-5437
Practice Address - Fax:865-588-1862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20601223G0001X
TN89001223G0001X
TN82031223P0221X
TN96071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506673Medicaid
TN5440289Medicaid
TN1531634Medicaid
TN5440284Medicaid