Organization
EUGENE STINSON DDS
Active
Other names
Kodak Dental Care, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
KAY HARRISON (OFFICE MANAGER)
(865) 465-7058
Entity
Organization
Contact information
Practice address
2946 WINFIELD DUNN PKWY, SUITE 301, KODAK, TN 37764-4306
(865) 465-7058
(865) 465-3432
Mailing address
2946 WINFIELD DUNN PKWY, SUITE 301, KODAK, TN 37764-4306
(865) 465-7058
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DS0000003957
TN
1223G0001X
General Practice Dentistry
Primary
DS0000005043
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3225522
—
TN
01
—
5440268
TENNCARE
TN
Enumeration date
10/30/2015
Last updated
10/30/2015
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