# MARYVILLE DENTAL CARE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Maryville Dental Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083338644
- **Authorized official:** MRS. LAURA BULL (OFFICE)
- **Authorized official phone:** (865) 483-7851

## Contact information

- **Practice address:** 1401 MONTVALE STATION RD, MARYVILLE, TN 37803-5815
- **Practice address phone:** (865) 984-3800
- **Mailing address:** 400 LABORATORY RD STE 101, OAK RIDGE, TN 37830-6808
- **Mailing address phone:** (865) 483-7851
- **Mailing address fax:** (865) 483-6391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2022
- **Last updated:** 09/28/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1881190619 | NPI | TN |