Provider Demographics
NPI:1457591190
Name:ASSOCIATED DENTAL PROFESSIONALS WEST
Entity Type:Organization
Organization Name:ASSOCIATED DENTAL PROFESSIONALS WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-691-2330
Mailing Address - Street 1:8874 KINGSTON PIKE, SUITE 102
Mailing Address - Street 2:ASSOCIATED DENTAL PROFESSIONALS WEST
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5013
Mailing Address - Country:US
Mailing Address - Phone:865-691-2330
Mailing Address - Fax:865-691-2344
Practice Address - Street 1:8874 KINGSTON PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5013
Practice Address - Country:US
Practice Address - Phone:865-691-2330
Practice Address - Fax:865-691-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 36381223G0001X
TNDS 52781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty