Provider Demographics
NPI:1134152184
Name:BREEDING, PHILIP J (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:BREEDING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 OFFICE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1161
Mailing Address - Country:US
Mailing Address - Phone:865-584-3510
Mailing Address - Fax:865-584-3811
Practice Address - Street 1:6908 OFFICE PARK CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1161
Practice Address - Country:US
Practice Address - Phone:865-584-3510
Practice Address - Fax:865-584-3811
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621762610OtherTAX ID#