Organization
LAKEVIEW DENTAL STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYLEN HADERLIE DDS (OWNER)
(816) 646-1057
Entity
Organization
Contact information
Practice address
5315 FOUNTAIN RD, KNOXVILLE, TN 37918-3094
(865) 687-6763
Mailing address
5315 FOUNTAIN RD, KNOXVILLE, TN 37918-3094
(865) 687-6763
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/21/2024
Last updated
05/21/2024
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