Provider Demographics
NPI:1487941746
Name:DIVISION DENTAL P.C.
Entity type:Organization
Organization Name:DIVISION DENTAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-789-4672
Mailing Address - Street 1:138 E DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6906
Mailing Address - Country:US
Mailing Address - Phone:865-272-3661
Mailing Address - Fax:865-272-3663
Practice Address - Street 1:138 E DIVISION RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6906
Practice Address - Country:US
Practice Address - Phone:865-272-3661
Practice Address - Fax:865-272-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440305Medicaid