| NPI | 1154407088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN GROSS Dds/Owner 865-986-4582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS7297) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-08-22 |