Provider Demographics
NPI:1649641440
Name:TOWN CREEK FAMILY DENTISTRY
Entity type:Organization
Organization Name:TOWN CREEK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-262-4965
Mailing Address - Street 1:410 MOSER LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4043
Mailing Address - Country:US
Mailing Address - Phone:901-262-4965
Mailing Address - Fax:
Practice Address - Street 1:875 HIGHWAY 321 N
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-7397
Practice Address - Country:US
Practice Address - Phone:865-816-6327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty