Provider Demographics
NPI:1801116272
Name:CRESTVIEW DENTAL CARE, P.C.
Entity type:Organization
Organization Name:CRESTVIEW DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-982-1700
Mailing Address - Street 1:1850 CREST ROAD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-4305
Mailing Address - Country:US
Mailing Address - Phone:865-982-1700
Mailing Address - Fax:865-982-1746
Practice Address - Street 1:1850 CREST ROAD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-4305
Practice Address - Country:US
Practice Address - Phone:865-982-1700
Practice Address - Fax:865-982-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA87341223G0001X
TN47351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty