Provider Demographics
NPI:1699286856
Name:COMMUNITY FAMILY DENTISTRY
Entity type:Organization
Organization Name:COMMUNITY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHERANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-466-0327
Mailing Address - Street 1:1107 GRAY EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932-1591
Mailing Address - Country:US
Mailing Address - Phone:865-466-0327
Mailing Address - Fax:
Practice Address - Street 1:116 CUMBERLAND LN # 1
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2737
Practice Address - Country:US
Practice Address - Phone:423-562-9459
Practice Address - Fax:423-566-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty