Provider Demographics
NPI:1861013195
Name:TENNESSEE VALLEY ORAL SURGERY. PLLC
Entity Type:Organization
Organization Name:TENNESSEE VALLEY ORAL SURGERY. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-381-8867
Mailing Address - Street 1:205 SOUTHDOWNE DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3747
Mailing Address - Country:US
Mailing Address - Phone:865-381-8867
Mailing Address - Fax:865-724-1803
Practice Address - Street 1:205 SOUTHDOWNE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3747
Practice Address - Country:US
Practice Address - Phone:865-381-8867
Practice Address - Fax:865-724-1803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty