Provider Demographics
NPI:1902052822
Name:NORTHSHORE DENTAL ARTS LLC
Entity Type:Organization
Organization Name:NORTHSHORE DENTAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HULSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-640-5283
Mailing Address - Street 1:7424 S NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-8822
Mailing Address - Country:US
Mailing Address - Phone:865-247-0069
Mailing Address - Fax:865-247-0071
Practice Address - Street 1:7424 S NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-8822
Practice Address - Country:US
Practice Address - Phone:865-247-0069
Practice Address - Fax:865-247-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty