Provider Demographics
NPI:1447627914
Name:KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Entity type:Organization
Organization Name:KNOXVILLE PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERRITY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-522-5437
Mailing Address - Street 1:818 MIDDLE CREEK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5017
Mailing Address - Country:US
Mailing Address - Phone:865-622-9144
Mailing Address - Fax:865-622-5951
Practice Address - Street 1:818 MIDDLE CREEK RD STE 1
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5017
Practice Address - Country:US
Practice Address - Phone:865-622-9144
Practice Address - Fax:865-622-5951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82031223P0221X
TN96071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty