Provider Demographics
NPI:1790920650
Name:ABC FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:ABC FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KNOP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:423-639-2176
Mailing Address - Street 1:1018 TUSCULUM BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-4037
Mailing Address - Country:US
Mailing Address - Phone:423-639-2176
Mailing Address - Fax:423-639-2177
Practice Address - Street 1:1018 TUSCULUM BLVD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4037
Practice Address - Country:US
Practice Address - Phone:423-639-2176
Practice Address - Fax:423-639-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-07
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X, 332BC3200X
TN8843261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty