Provider Demographics
NPI:1639541543
Name:EUGENE STINSON DDS
Entity Type:Organization
Organization Name:EUGENE STINSON DDS
Other - Org Name:KODAK DENTAL CARE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-465-7058
Mailing Address - Street 1:2946 WINFIELD DUNN PKWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-4306
Mailing Address - Country:US
Mailing Address - Phone:865-465-7058
Mailing Address - Fax:
Practice Address - Street 1:2946 WINFIELD DUNN PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-4306
Practice Address - Country:US
Practice Address - Phone:865-465-7058
Practice Address - Fax:865-465-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000050431223G0001X
TNDS00000039571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225522Medicaid
TN5440268OtherTENNCARE