Provider Demographics
NPI:1982818266
Name:DR THOMAS H STILLWELL DDS PC
Entity Type:Organization
Organization Name:DR THOMAS H STILLWELL DDS PC
Other - Org Name:ATHENS DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:STILLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-744-0668
Mailing Address - Street 1:1504 DECATUR PIKE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-2422
Mailing Address - Country:US
Mailing Address - Phone:423-744-0668
Mailing Address - Fax:
Practice Address - Street 1:1504 DECATUR PIKE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2422
Practice Address - Country:US
Practice Address - Phone:423-744-0668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000070491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty