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Organization
MABRY FAMILY DENTISTRY
Active
Organization
MABRY FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LOU FOX (MANAGER)
(865) 566-2158
Entity
Organization
Contact information
Practice address
600 TOWN CREEK RD. EAST, LENOIR CITY, TN 37772
(865) 564-6001
(865) 564-6003
Mailing address
600 TOWN CREEK RD. EAST, LENOIR CITY, TN 37772
(865) 564-6001
(865) 564-6003
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11084
DENTIST LICENSE NUMBER
TN
01
—
4480
DENTIST LICENSE NUMBER
TN
Enumeration date
11/07/2022
Last updated
11/07/2022
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