Provider Demographics
NPI:1730287087
Name:VONORE DENTAL PRACTICE P C
Entity Type:Organization
Organization Name:VONORE DENTAL PRACTICE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:FUGATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-884-2300
Mailing Address - Street 1:1277 HIGHWAY 411
Mailing Address - Street 2:
Mailing Address - City:VONORE
Mailing Address - State:TN
Mailing Address - Zip Code:37885-2456
Mailing Address - Country:US
Mailing Address - Phone:423-884-2300
Mailing Address - Fax:423-884-2981
Practice Address - Street 1:1277 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:VONORE
Practice Address - State:TN
Practice Address - Zip Code:37885-2456
Practice Address - Country:US
Practice Address - Phone:423-884-2300
Practice Address - Fax:423-884-2981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519925Medicaid