Provider Demographics
NPI:1477677474
Name:STINSON, EUGENE WOODY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:WOODY
Last Name:STINSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8874 KINGSTON PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-691-2330
Mailing Address - Fax:865-691-2344
Practice Address - Street 1:8874 KINGSTON PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-691-2330
Practice Address - Fax:865-691-2344
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-50431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440268OtherTENNCARE
TN3225522Medicaid