Provider Demographics
NPI:1194249698
Name:PABLO A. FONCEA, DMD, PC
Entity type:Organization
Organization Name:PABLO A. FONCEA, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:FONCEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-973-9899
Mailing Address - Street 1:2719 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4620
Mailing Address - Country:US
Mailing Address - Phone:865-973-9899
Mailing Address - Fax:865-524-0194
Practice Address - Street 1:2719 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4620
Practice Address - Country:US
Practice Address - Phone:865-973-9899
Practice Address - Fax:865-524-0194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental