Provider Demographics
NPI:1518066059
Name:EAST TENNESSEE PROSTHODONTICS
Entity Type:Organization
Organization Name:EAST TENNESSEE PROSTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LOCASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-769-0886
Mailing Address - Street 1:8904 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-769-0886
Mailing Address - Fax:865-769-0823
Practice Address - Street 1:8904 EXECUTIVE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-769-0886
Practice Address - Fax:865-769-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN74461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3226557Medicare ID - Type Unspecified