Organization
JEFFERSON DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA B FAIRBANKS (OFFICE MANAGER)
(865) 475-8988
Entity
Organization
Contact information
Practice address
1205 GEORGE AVE, JEFFERSON CITY, TN 37760-2759
(865) 475-8988
(865) 475-1103
Mailing address
1205 GEORGE AVE, JEFFERSON CITY, TN 37760-2759
(865) 475-8988
(865) 475-1103
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DS0000003187
TN
Other
Enumeration date
06/05/2012
Last updated
06/05/2012
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