# FOOTHILLS ORAL AND MAXILLOFACIAL SURGERY, PC

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

## Provider details

- **NPI number:** 1154407088
- **Authorized official:** KEVIN GROSS (DDS/OWNER)
- **Authorized official phone:** (865) 986-4582

## Contact information

- **Practice address:** 603 HIGHWAY 321 N, BLDG. 4, UNIT 20, LENOIR CITY, TN 37771-6575
- **Practice address phone:** (865) 986-4582
- **Mailing address:** PO BOX 4879, MARYVILLE, TN 37802-4879
- **Mailing address phone:** (865) 986-3865

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS7297 | TN | Yes |

## Other

- **Enumeration date:** 10/31/2006
- **Last updated:** 08/22/2020