Organization
TENNESSEE RIVER DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCUS KENNETH RANDALL D.M.D. (OWNER)
(423) 877-3848
Entity
Organization
Contact information
Practice address
4845 HIXSON PIKE STE C, HIXSON, TN 37343-4466
(423) 877-3848
(423) 877-3726
Mailing address
4845 HIXSON PIKE STE C, HIXSON, TN 37343-4466
(423) 877-3848
(423) 877-3726
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
3483
TN
261QD0000X
Dental Clinic/Center
Primary
9947
TN
Other
Enumeration date
02/23/2015
Last updated
02/23/2015
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