| NPI | 1083975221 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA B FAIRBANKS Office Manager 865-475-8988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: TN DS0000003187) |
| Enumeration Date | 2012-06-05 |
| Last Update Date | 2012-06-05 |