Provider Demographics
NPI:1952472086
Name:PROFESSIONAL DENTAL SYSTEMS, NORTH
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL SYSTEMS, NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-688-1320
Mailing Address - Street 1:2609 ADAIR DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-1897
Mailing Address - Country:US
Mailing Address - Phone:865-688-1320
Mailing Address - Fax:865-688-4719
Practice Address - Street 1:2609 ADAIR DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-1897
Practice Address - Country:US
Practice Address - Phone:865-688-1320
Practice Address - Fax:865-688-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherEIN