=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255850400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R ANDREW TURNER DDS MDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2017
-----------------------------------------------------
Last Update Date | 09/19/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4233 HIGHWAY 411
-----------------------------------------------------
City | MADISONVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37354-1571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-742-2587
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9511 TWELVE TREES LN
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-3428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MR. JUSTIN HACKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-969-4934
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------