1437423217 NPI number — MICHAEL E. EDENFIELD, DDS, PC

Table of content: (NPI 1437423217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437423217 NPI number — MICHAEL E. EDENFIELD, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL E. EDENFIELD, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437423217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2937 ESSARY RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-686-0050
Provider Business Mailing Address Fax Number:
865-686-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2937 ESSARY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-686-0050
Provider Business Practice Location Address Fax Number:
865-686-0053
Provider Enumeration Date:
02/27/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EDENFIELD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
865-686-0050

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS0000008123 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: DS0000008822 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DS0000009153 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)