=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962343269
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSE MOUNTAIN DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2026
-----------------------------------------------------
Last Update Date | 04/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1070 RUTLEDGE PIKE
-----------------------------------------------------
City | BLAINE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37709-3027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-401-2796
-----------------------------------------------------
Fax | 865-992-3042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3802 MAYNARDVILLE HWY
-----------------------------------------------------
City | MAYNARDVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37807-3413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-992-5821
-----------------------------------------------------
Fax | 865-992-3042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RDH
-----------------------------------------------------
Name | DEBBIE M LONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 865-992-5821
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------