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General NPI Number Information
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NPI Number | 1255997359
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Entity Type | Organization
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Legal Business Name | JOHNSON CITY SMILES, LLC
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 2800 PEOPLES ST STE 90
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4158
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Country | US
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Telephone | 423-928-0345
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Fax | 423-926-4358
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Provider Business Mailing Address
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Address Line | 2800 PEOPLES ST STE 90
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4158
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Country | US
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Telephone | 423-928-0345
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Fax | 423-926-4358
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARK D DAMRON
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Credential | DMD
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Telephone | 423-928-0345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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