Provider Demographics
NPI:1609235712
Name:FOOTHILLS ENDODONTICS
Entity Type:Organization
Organization Name:FOOTHILLS ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVEDAY
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:865-982-8000
Mailing Address - Street 1:312 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804
Mailing Address - Country:US
Mailing Address - Phone:865-982-8000
Mailing Address - Fax:865-982-8512
Practice Address - Street 1:312 HIGH ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5833
Practice Address - Country:US
Practice Address - Phone:865-982-8000
Practice Address - Fax:865-982-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty