Provider Demographics
NPI:1528293164
Name:KNOXVILLE PERIODONTICS, P.C.
Entity type:Organization
Organization Name:KNOXVILLE PERIODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-693-2331
Mailing Address - Street 1:140 MARKET PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2337
Mailing Address - Country:US
Mailing Address - Phone:865-693-2331
Mailing Address - Fax:865-691-8340
Practice Address - Street 1:140 MARKET PLACE BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2337
Practice Address - Country:US
Practice Address - Phone:865-693-2331
Practice Address - Fax:865-691-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS86661223P0300X
TNDS21881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty