| NPI | 1154596286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE L TRACY Office Manager 865-977-7110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2009-04-15 |