Provider Demographics
NPI:1215944988
Name:S. GRAYSON EDDY, D.D.S.,P.C.
Entity type:Organization
Organization Name:S. GRAYSON EDDY, D.D.S.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GRAYSON
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-579-3000
Mailing Address - Street 1:3221 W GOVERNOR JOHN SEVIER HWY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-5540
Mailing Address - Country:US
Mailing Address - Phone:865-579-3000
Mailing Address - Fax:865-579-3056
Practice Address - Street 1:3221 W GOVERNOR JOHN SEVIER HWY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-5540
Practice Address - Country:US
Practice Address - Phone:865-579-3000
Practice Address - Fax:865-579-3056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 19161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty