# MARYVILLE DENTAL, PLLC.

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

## Provider details

- **NPI number:** 1336863257
- **Authorized official:** AMY HUGHES (OFFICE MANAGER)
- **Authorized official phone:** (865) 440-1526

## Contact information

- **Practice address:** 1765 W BROADWAY AVE, MARYVILLE, TN 37801-5509
- **Practice address phone:** (865) 440-1526
- **Mailing address:** 7456 RAVENCREST LN, CORRYTON, TN 37721-3735
- **Mailing address phone:** (865) 440-1526

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/04/2022
- **Last updated:** 10/04/2022