Provider Demographics
NPI:1780676429
Name:PHDC OF KNOXVILLE, P.C.
Entity Type:Organization
Organization Name:PHDC OF KNOXVILLE, P.C.
Other - Org Name:WESTERN HEIGHTS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:865-522-1244
Mailing Address - Street 1:801 W OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-2747
Mailing Address - Country:US
Mailing Address - Phone:865-522-1244
Mailing Address - Fax:865-525-7041
Practice Address - Street 1:801 W OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-2747
Practice Address - Country:US
Practice Address - Phone:865-522-1244
Practice Address - Fax:865-525-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530868Medicaid