MEDICARE: DR. JOHN C. PRYSE,JR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2666	TN

General Provider Information

NPI Number	:	1356491666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN C. PRYSE,JR. DDS

Provider Business Mailing Address
First Line	:	180 EDGEWOOD AVE
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-2817
Country	:	US
Telephone Number	:	865-457-2299
Fax Number	:	865-463-8223

Provider Business Practice Location Address
First Line	:	180 EDGEWOOD AVE
Second Line	:
City	:	CLINTON
State	:	TN
Zip	:	37716-2817
Country	:	US
Telephone Number	:	865-457-2299
Fax Number	:	865-463-8223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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