Organization
SMOKY MOUNTAIN PEDIATRIC DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE BODFORD MALONE DDS (PEDIATRIC DENTIST)
(865) 766-4884
Entity
Organization
Contact information
Practice address
550 TOWN CREEK RD E, SUITE 101, LENOIR CITY, TN 37772-6289
(865) 766-4884
Mailing address
550 TOWN CREEK RD E, SUITE 101, LENOIR CITY, TN 37772-6289
(865) 766-4884
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
9031
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1522864
—
TN
Enumeration date
01/29/2014
Last updated
06/07/2014
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