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General NPI Number Information
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NPI Number | 1437658507
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL AND ANESTHESIA SOLUTIONS LLC
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 135 MARKETPLACE DR STE 101
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City | JOHNSON CITY
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State | TN
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Zip | 37604-8933
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Country | US
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Telephone | 423-483-0945
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5610
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City | JOHNSON CITY
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State | TN
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Zip | 37602-5610
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Country | US
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Telephone | 423-483-0945
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SHAWN BRIGHT
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Credential | CRNA
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Telephone | 423-483-0945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | TN
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