Provider Demographics
NPI:1982364741
Name:LOUDON DENTAL ARTS PLLC
Entity Type:Organization
Organization Name:LOUDON DENTAL ARTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-384-2105
Mailing Address - Street 1:2235 FRIENDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-4805
Mailing Address - Country:US
Mailing Address - Phone:423-384-2105
Mailing Address - Fax:
Practice Address - Street 1:705 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-1123
Practice Address - Country:US
Practice Address - Phone:865-458-4396
Practice Address - Fax:865-458-4605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental