Healthcare Provider Details

I. General information

NPI: 1033211172
Provider Name (Legal Business Name): GREGORY S SEXTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3215
US

IV. Provider business mailing address

2729 W ANDREW JOHNSON HWY
MORRISTOWN TN
37814-3215
US

V. Phone/Fax

Practice location:
  • Phone: 423-586-3611
  • Fax: 423-586-7454
Mailing address:
  • Phone: 423-586-3611
  • Fax: 423-586-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04773
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: