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General NPI Number Information
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NPI Number | 1467868471
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Entity Type | Organization
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Legal Business Name | AFFORDABLE EXTRACTIONS
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 300 W WATAUGA AVE SUITE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5549
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Country | US
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Telephone | 423-232-7343
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Fax | 423-232-7337
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Provider Business Mailing Address
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Address Line | 300 W WATAUGA AVE SUITE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5549
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Country | US
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Telephone | 423-232-7343
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Fax | 423-232-7337
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON E CUNNINGHAM
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Credential | DDS, FAGD
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Telephone | 423-232-7343
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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 | 7771
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License Number State | TN
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