Provider Demographics
NPI:1588558068
Name:CORYELL, SCOTT M
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:CORYELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12113 MALLARD BAY DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9360
Mailing Address - Country:US
Mailing Address - Phone:206-601-5327
Mailing Address - Fax:
Practice Address - Street 1:12802 KINGSTON PIKE STE 101
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-0965
Practice Address - Country:US
Practice Address - Phone:865-518-2297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN128331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice