Provider Demographics
NPI:1073155511
Name:KNOXVILLE FAMILY DENTAL
Entity type:Organization
Organization Name:KNOXVILLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF INTEGRATION
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOESTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-675-3088
Mailing Address - Street 1:3483 COASTLINE LN
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6587
Mailing Address - Country:US
Mailing Address - Phone:549-675-3088
Mailing Address - Fax:
Practice Address - Street 1:4947 MILLERTOWN PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2115
Practice Address - Country:US
Practice Address - Phone:865-544-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty