Organization
KNOXVILLE ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL D WOOTEN DDS (CEO)
(865) 584-6207
Entity
Organization
Contact information
Practice address
6207 HIGHLAND PLACE WAY, KNOXVILLE, TN 37919-4027
(865) 584-6207
(865) 934-0080
Mailing address
6207 HIGHLAND PLACE WAY, STE 207, KNOXVILLE, TN 37919-4027
(865) 584-6207
(865) 934-0080
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4447359
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
400149
BLUE CROSS
—
01
—
5315104
AETNA
—
Enumeration date
11/11/2005
Last updated
08/22/2020
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