NPIMap

Organization Active NPI

Pediatric Dentistry PC

  • Pediatric Dentistry
  • Knoxville, TN
National Provider Identifier
1437557378
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
9902 Issued in TN
Legal business name
PEDIATRIC DENTISTRY PC
Doing business as
Pediatric Dentistry, P.C.
Practice address
1516 Coleman Rd
Suite 201
Knoxville, TN 37909-3809
Phone
(865) 558-8857
Fax
(865) 558-0291
NPI assigned
Dec 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Authorized official

Name
Dr. Michael James Koch, DC
Title
Business Manager
Phone
(865) 558-8857

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 9902 TN Primary
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 3722 TN

Addresses

Primary practice location

1516 Coleman Rd
Suite 201
Knoxville, TN 37909-3809

Mailing address

1516 Coleman Rd
Suite 201
Knoxville, TN 37909-3809
Phone (865) 558-8857

Other names 1

  • Pediatric Dentistry, P.C. Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Dentistry PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1516 Coleman Rd
Ste 201
Knoxville, TN 37909
Phone (865) 558-8857

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1437557378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 COLEMAN RD",
            "address_2": "SUITE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379093809",
            "telephone_number": "865-558-8857",
            "fax_number": "865-558-0291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 COLEMAN RD",
            "address_2": "SUITE 201",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379093809",
            "telephone_number": "865-558-8857",
            "fax_number": "865-558-0291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "KOCH",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "865-558-8857",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "9902",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "3722",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pediatric Dentistry, P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.