NPIMap

Organization Active NPI

East Tennessee Pediatric Dentistry PLLC

  • Pediatric Dentistry
  • Knoxville, TN
National Provider Identifier
1609211267
Registry record updated Jan 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
9446 Issued in TN
Legal business name
EAST TENNESSEE PEDIATRIC DENTISTRY PLLC
Practice address
1103 Callahan Dr
Knoxville, TN 37912-1310
Phone
(865) 859-0355
Fax
(865) 859-0227
NPI assigned
May 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2017

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

Authorized official

Name
Dr. Jessica Phillips, DMDNPI 1881912376
Title
Owner
Phone
(865) 859-0355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 9446 TN Primary

Addresses

Primary practice location

1103 Callahan Dr
Knoxville, TN 37912-1310

Mailing address

1103 Callahan Dr
Knoxville, TN 37912-1310
Phone (865) 859-0355

National Provider Directory

National Provider Directory

Locations

1103 Callahan Dr
Knoxville, TN 37912
Phone (865) 859-0355

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": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1609211267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 CALLAHAN DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379121310",
            "telephone_number": "865-859-0355",
            "fax_number": "865-859-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 CALLAHAN DR",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379121310",
            "telephone_number": "865-859-0355",
            "fax_number": "865-859-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST TENNESSEE PEDIATRIC DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-859-0355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "9446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jan 9, 2017; 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.