Provider Demographics
NPI:1467783787
Name:EDDY, SAMUEL GRAYSON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GRAYSON
Last Name:EDDY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3221 W JOHN SEVIER HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5540
Mailing Address - Country:US
Mailing Address - Phone:865-579-3000
Mailing Address - Fax:865-579-3056
Practice Address - Street 1:3221 W JOHN SEVIER HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5540
Practice Address - Country:US
Practice Address - Phone:865-579-3000
Practice Address - Fax:865-579-3056
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS19161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics