Provider Demographics
NPI:1336351451
Name:CORNERSTONE DENTAL ARTS ASSOC
Entity Type:Organization
Organization Name:CORNERSTONE DENTAL ARTS ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-691-0995
Mailing Address - Street 1:8912 TOWN AND COUNTRY CIR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4900
Mailing Address - Country:US
Mailing Address - Phone:865-691-0995
Mailing Address - Fax:
Practice Address - Street 1:8912 TOWN AND COUNTRY CIR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4900
Practice Address - Country:US
Practice Address - Phone:865-691-0995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS79861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty