Provider Demographics
NPI:1699283432
Name:PEDIATRIC DENTISTRY PC
Entity type:Organization
Organization Name:PEDIATRIC DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-558-8857
Mailing Address - Street 1:209 E EMORY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-4016
Mailing Address - Country:US
Mailing Address - Phone:865-558-8857
Mailing Address - Fax:
Practice Address - Street 1:209 E EMORY RD STE 101
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4016
Practice Address - Country:US
Practice Address - Phone:865-558-8857
Practice Address - Fax:865-558-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1467573911Medicaid