Provider Demographics
NPI:1558097857
Name:EAST TENNESSEE FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:EAST TENNESSEE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-8630
Mailing Address - Street 1:6311 KINGSTON PIKE STE 8W
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4906
Mailing Address - Country:US
Mailing Address - Phone:865-584-8630
Mailing Address - Fax:
Practice Address - Street 1:150 E DIVISION RD STE 6
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6908
Practice Address - Country:US
Practice Address - Phone:865-482-1701
Practice Address - Fax:865-482-6176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1215017595OtherINDIVIDUAL NPI
TN1518585918OtherNPI