Maryville Dental, PLLC.

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MARYVILLE DENTAL, PLLC.

Doing business as

Maryville Dental

Practice address

1765 W Broadway Ave
Maryville, TN 37801-5509

Phone

(865) 440-1526

NPI assigned

Oct 4, 2022

Last updated

Oct 4, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Hughes

Title

Office Manager

Phone

(865) 440-1526

Specialties & licenses 1

Addresses

Other names 1

• Maryville Dental Doing business as

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664841600000",
    "number": "1336863257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7456 RAVENCREST LN",
            "city": "CORRYTON",
            "state": "TN",
            "postal_code": "377213735",
            "telephone_number": "865-440-1526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 W BROADWAY AVE",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378015509",
            "telephone_number": "865-440-1526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARYVILLE DENTAL, PLLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-04",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "865-440-1526"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "URL",
            "affiliation": "N",
            "address_1": "1765 W Broadway Ave",
            "city": "Maryville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "378015509",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Maryville Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephenie Ann Martin, B.S.
• Tracy Dale Martin, PT, ATC
• Maryville Anesthesiologists PC
• Maryville ASC (Tennessee Endoscopy Center)
• Maryville Dental Care
• Maryville Fairpark Opco LLC (Fairpark Health and Rehabilitation)
• Maryville Foot Clinic Inc
• Maryville Jamestown Opco LLC (Foothills Transitional Care and Rehabilitation)
• Maryville Massage
• Maryville Surgical Center

• Dental Clinic/Center in Maryville, TN
• Providers in Maryville, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.