Provider Demographics
NPI:1659996320
Name:PICKERING & ALLEN ORTHODONTICS
Entity Type:Organization
Organization Name:PICKERING & ALLEN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-687-9412
Mailing Address - Street 1:4741 N BROADWAY ST STE C
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1793
Mailing Address - Country:US
Mailing Address - Phone:865-687-9412
Mailing Address - Fax:865-688-0656
Practice Address - Street 1:4741 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1793
Practice Address - Country:US
Practice Address - Phone:865-687-9412
Practice Address - Fax:865-688-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037787Medicaid
TNQ006553Medicaid