Provider Demographics
NPI:1174977953
Name:APPALACHIAN DENTAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:APPALACHIAN DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-283-4442
Mailing Address - Street 1:801 SUNSET DR
Mailing Address - Street 2:BUILDING A, SUITE 5
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3033
Mailing Address - Country:US
Mailing Address - Phone:423-283-4442
Mailing Address - Fax:423-283-3064
Practice Address - Street 1:801 SUNSET DR
Practice Address - Street 2:BUILDING A, SUITE 5
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3033
Practice Address - Country:US
Practice Address - Phone:423-283-4442
Practice Address - Fax:423-283-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty