Healthcare Provider Details

I. General information

NPI: 1114980349
Provider Name (Legal Business Name): JOHN S PAFFRATH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4889 EAST MAIN STREET
ERIN TN
37061-4115
US

IV. Provider business mailing address

4889 EAST MAIN STREET
ERIN TN
37061-4115
US

V. Phone/Fax

Practice location:
  • Phone: 931-289-4228
  • Fax: 931-289-5832
Mailing address:
  • Phone: 931-289-4228
  • Fax: 931-289-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS4216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: