| NPI | 1467968701 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA M HALL FISHER Executive Director 865-333-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS4867) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS) |
| 261QD0000X Clinic/Center, Dental (Licence: TN DS) | |
| Enumeration Date | 2017-12-22 |
| Last Update Date | 2017-12-22 |