Provider Demographics
NPI:1467950790
Name:INFIRM CARE DENTAL SERVICES, INC.
Entity Type:Organization
Organization Name:INFIRM CARE DENTAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:N
Authorized Official - Last Name:GENGOZIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:865-206-6198
Mailing Address - Street 1:1143 OAK RIDGE TPKE STE 107A
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6422
Mailing Address - Country:US
Mailing Address - Phone:865-206-6198
Mailing Address - Fax:
Practice Address - Street 1:460 INDUSTRIAL LN
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6294
Practice Address - Country:US
Practice Address - Phone:865-206-6198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1007125K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes125K00000XDental ProvidersAdvanced Practice Dental TherapistGroup - Multi-Specialty