Provider Demographics
NPI:1568170835
Name:MABRY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MABRY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY LOU
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-566-2158
Mailing Address - Street 1:600 TOWN CREEK RD. EAST
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772
Mailing Address - Country:US
Mailing Address - Phone:865-564-6001
Mailing Address - Fax:865-564-6003
Practice Address - Street 1:600 TOWN CREEK RD. EAST
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772
Practice Address - Country:US
Practice Address - Phone:865-564-6001
Practice Address - Fax:865-564-6003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4480OtherDENTIST LICENSE NUMBER
TN11084OtherDENTIST LICENSE NUMBER