# CDA - FORT SANDERS WEST

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104690924
- **Authorized official:** MR. GARY MICHAEL PRINCE JR. (INSURANCE COORDINATOR)
- **Authorized official phone:** (865) 539-6030

## Contact information

- **Practice address:** 280 FORT SANDERS WEST BLVD STE 117, KNOXVILLE, TN 37922-3352
- **Practice address phone:** (865) 539-6030
- **Practice address fax:** (865) 539-6768
- **Mailing address:** 280 FORT SANDERS WEST BLVD STE 117, KNOXVILLE, TN 37922-3352
- **Mailing address phone:** (865) 539-6030
- **Mailing address fax:** (865) 539-6768

## Taxonomy

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

## Other

- **Enumeration date:** 11/13/2023
- **Last updated:** 11/13/2023