Provider Demographics
NPI:1780890004
Name:PARKWAY DENTAL OFFICE, P.C.
Entity type:Organization
Organization Name:PARKWAY DENTAL OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:LOVELY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-690-5231
Mailing Address - Street 1:12748 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5468
Mailing Address - Country:US
Mailing Address - Phone:865-690-5231
Mailing Address - Fax:865-691-4291
Practice Address - Street 1:323 FOX RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3383
Practice Address - Country:US
Practice Address - Phone:865-690-5231
Practice Address - Fax:865-691-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty