Provider Demographics
NPI:1689206179
Name:SOUTH KNOX DENTAL
Entity Type:Organization
Organization Name:SOUTH KNOX DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS/OPERATIONS MGR.
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:865-524-1265
Mailing Address - Street 1:6555 CHAPMAN HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-6579
Mailing Address - Country:US
Mailing Address - Phone:865-577-7535
Mailing Address - Fax:
Practice Address - Street 1:6555 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-6579
Practice Address - Country:US
Practice Address - Phone:865-577-7535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental