| NPI | 1255749339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK A OSBORNE Vice President 865-687-3203 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 5136) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 5028) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2014-08-01 |