Provider Demographics
NPI:1780159368
Name:TARA ERICSON
Entity type:Organization
Organization Name:TARA ERICSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-588-7862
Mailing Address - Street 1:6311 KINGSTON PIKE STE 27W
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4900
Mailing Address - Country:US
Mailing Address - Phone:865-588-7862
Mailing Address - Fax:865-558-6849
Practice Address - Street 1:6311 KINGSTON PIKE STE 27W
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4900
Practice Address - Country:US
Practice Address - Phone:865-588-7862
Practice Address - Fax:865-558-6849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty