Provider Demographics
NPI:1487847455
Name:LARRY E TRAGESSER DDS
Entity Type:Organization
Organization Name:LARRY E TRAGESSER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-693-1047
Mailing Address - Street 1:9000 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5230
Mailing Address - Country:US
Mailing Address - Phone:865-693-1047
Mailing Address - Fax:865-693-6602
Practice Address - Street 1:9000 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5230
Practice Address - Country:US
Practice Address - Phone:865-693-1047
Practice Address - Fax:865-693-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3038251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherDENTIST