Provider Demographics
NPI:1467968701
Name:PROJECT DENTAL ACCESS, INC.
Entity Type:Organization
Organization Name:PROJECT DENTAL ACCESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HALL FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RDH, RDA
Authorized Official - Phone:865-333-1611
Mailing Address - Street 1:PO BOX 31107
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1107
Mailing Address - Country:US
Mailing Address - Phone:865-333-1611
Mailing Address - Fax:800-879-9969
Practice Address - Street 1:9329 MIDDLEBROOK PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37931-4704
Practice Address - Country:US
Practice Address - Phone:865-333-1611
Practice Address - Fax:800-879-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS122300000X, 261QD0000X
TNDS4867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty