Provider Demographics
NPI:1477754141
Name:LOOKOUT VALLEY DENTAL P C
Entity Type:Organization
Organization Name:LOOKOUT VALLEY DENTAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-821-3279
Mailing Address - Street 1:3309 CUMMINGS HWY
Mailing Address - Street 2:SUITE F
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2376
Mailing Address - Country:US
Mailing Address - Phone:423-821-3279
Mailing Address - Fax:423-821-1620
Practice Address - Street 1:3309 CUMMINGS HWY
Practice Address - Street 2:SUITE F
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-2376
Practice Address - Country:US
Practice Address - Phone:423-821-3279
Practice Address - Fax:423-821-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty