Individual
DR. MICHAEL DEAN WOOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
6207 HIGHLAND PLACE WAY, SUITE 207, KNOXVILLE, TN 37919-4027
(865) 584-6207
(865) 934-0080
Mailing address
6207 HIGHLAND PLACE WAY, SUITE 207, KNOXVILLE, TN 37919-4027
(865) 584-6207
(865) 934-0080
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS4213
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3225414
—
TN
01
—
4000149
BCBS PROVIDER #
TN
01
—
DS4213
STATE LICENSE #
TN
Enumeration date
03/29/2007
Last updated
07/09/2007
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