Provider Demographics
NPI:1306915236
Name:KRISTIN KNIERIM DDS, MSD
Entity type:Organization
Organization Name:KRISTIN KNIERIM DDS, MSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:WATSON
Authorized Official - Last Name:KNIERIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:865-522-7572
Mailing Address - Street 1:601 S CONCORD ST
Mailing Address - Street 2:SUITE100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-3306
Mailing Address - Country:US
Mailing Address - Phone:865-522-7572
Mailing Address - Fax:865-522-6579
Practice Address - Street 1:601 S CONCORD ST
Practice Address - Street 2:SUITE100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-3306
Practice Address - Country:US
Practice Address - Phone:865-522-7572
Practice Address - Fax:865-522-6579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty