| NPI | 1679056683 |
|---|---|
| Doing Business As | MARYVILLE MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | PHILIP BATES Owner/Dds 865-223-6705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2022-06-14 |