Provider Demographics
NPI:1891708863
Name:FONCEA, PABLO (DMD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:FONCEA
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 1:2719 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4620
Mailing Address - Country:US
Mailing Address - Phone:865-973-9899
Mailing Address - Fax:865-524-0194
Practice Address - Street 1:2719 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4620
Practice Address - Country:US
Practice Address - Phone:865-973-9899
Practice Address - Fax:865-524-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND57813TN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice