Provider Demographics
NPI:1649558859
Name:JEFFREY J. EBERTING DMD, M.S. PC
Entity Type:Organization
Organization Name:JEFFREY J. EBERTING DMD, M.S. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:EBERTING
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:865-983-3570
Mailing Address - Street 1:619 SMITHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37803-6100
Mailing Address - Country:US
Mailing Address - Phone:865-983-3570
Mailing Address - Fax:865-983-9547
Practice Address - Street 1:619 SMITHVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37803-6100
Practice Address - Country:US
Practice Address - Phone:865-983-3570
Practice Address - Fax:865-983-9547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty