Provider Demographics
NPI:1508981176
Name:CHILDERS, DAVID HONALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HONALD
Last Name:CHILDERS
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 1:150 E DIVISION RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6938
Mailing Address - Country:US
Mailing Address - Phone:865-483-6103
Mailing Address - Fax:865-482-8689
Practice Address - Street 1:150 E DIVISION RD
Practice Address - Street 2:SUITE #3
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6938
Practice Address - Country:US
Practice Address - Phone:865-483-6103
Practice Address - Fax:865-482-8689
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS31471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice