Provider Demographics
NPI:1821747346
Name:KNOXVILLE COSMETIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:KNOXVILLE COSMETIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAIRAV
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-966-4035
Mailing Address - Street 1:10642 DEERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-1941
Mailing Address - Country:US
Mailing Address - Phone:865-966-4035
Mailing Address - Fax:865-966-4035
Practice Address - Street 1:10642 DEERBROOK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-1941
Practice Address - Country:US
Practice Address - Phone:865-966-4035
Practice Address - Fax:865-675-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-22
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center