Provider Demographics
NPI:1730204876
Name:PELOT, REUBEN N III (DDS)
Entity type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:N
Last Name:PELOT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11541 KINGSTON PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-3918
Mailing Address - Country:US
Mailing Address - Phone:865-671-1154
Mailing Address - Fax:865-966-7548
Practice Address - Street 1:11541 KINGSTON PKE
Practice Address - Street 2:SUITE B
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934
Practice Address - Country:US
Practice Address - Phone:865-671-1544
Practice Address - Fax:865-966-7548
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN12721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice