Healthcare Provider Details

I. General information

NPI: 1114921178
Provider Name (Legal Business Name): APPALACHIAN LIFE QUALITY INITISTIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 COURT STREET
HUNTSVILLE TN
37756
US

IV. Provider business mailing address

PO BOX 210
HUNTSVILLE TN
37756-0210
US

V. Phone/Fax

Practice location:
  • Phone: 423-663-8200
  • Fax: 423-663-8544
Mailing address:
  • Phone: 423-663-8200
  • Fax: 423-663-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALLEN DANIELS
Title or Position: DENTIST
Credential:
Phone: 423-663-8200