Provider Demographics
NPI:1831303684
Name:KONRAD, MICHAEL EARNEST (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EARNEST
Last Name:KONRAD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5130
Mailing Address - Country:US
Mailing Address - Phone:865-982-6090
Mailing Address - Fax:865-982-9370
Practice Address - Street 1:1123 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5130
Practice Address - Country:US
Practice Address - Phone:865-982-6090
Practice Address - Fax:865-982-9370
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS4717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist