Provider Demographics
NPI:1528192861
Name:WALTER D. FAIN D.D.S. P.C.
Entity Type:Organization
Organization Name:WALTER D. FAIN D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-524-4697
Mailing Address - Street 1:2607 KINGSTON PIKE
Mailing Address - Street 2:STE 185
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3333
Mailing Address - Country:US
Mailing Address - Phone:865-524-4697
Mailing Address - Fax:865-524-4053
Practice Address - Street 1:2607 KINGSTON PIKE
Practice Address - Street 2:STE 185
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3333
Practice Address - Country:US
Practice Address - Phone:865-524-4697
Practice Address - Fax:865-524-4053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS2180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty