| Kodak Dental Care, Pllc | |
|
2946 Winfield Dunn Pkwy Suite 301 Kodak TN 37764-4306 | |
| (865) 465-7058 | |
| (865) 465-3432 |
| Full Name | Kodak Dental Care, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2946 Winfield Dunn Pkwy, Kodak, Tennessee |
| Authorized Official Name and Position | Kay Harrison (OFFICE MANAGER) |
| Authorized Official Contact | 8654657058 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kodak Dental Care, Pllc 2946 Winfield Dunn Pkwy Suite 301 Kodak TN 37764-4306 Ph: (865) 465-7058 | Kodak Dental Care, Pllc 2946 Winfield Dunn Pkwy Suite 301 Kodak TN 37764-4306 Ph: (865) 465-7058 |
| NPI Number | 1639541543 |
|---|---|
| Provider Enumeration Date | 10/30/2015 |
| Last Update Date | 10/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639541543 | NPI | - | NPPES |
| 3225522 | Medicaid | TN | |
| 5440268 | Other | TN | TENNCARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DS0000005043 (Tennessee) | Primary |
| 1223G0001X | Dentist - General Practice | DS0000003957 (Tennessee) | Secondary |
Kodak Family Dental, Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2946 Winfield Dunn Pkwy Ste 301, Kodak, TN 37764 Phone: 865-465-7058 |