Healthcare Provider Details

I. General information

NPI: 1881142859
Provider Name (Legal Business Name): JOHN A. MASENGILL, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W MACON LN
SEYMOUR TN
37865-4776
US

IV. Provider business mailing address

127 W MACON LN
SEYMOUR TN
37865-4776
US

V. Phone/Fax

Practice location:
  • Phone: 865-573-7330
  • Fax:
Mailing address:
  • Phone: 865-573-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS9638
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS8691
License Number StateTN

VIII. Authorized Official

Name: DR. JOHN ARTHUR MASENGILL
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 865-356-6929