# NORTHEAST TN PUBLIC HEALTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013991686
- **Authorized official:** DR. REBECCA B VESTAL DDS (DENTAL DIRECTOR)
- **Authorized official phone:** (423) 979-3200

## Contact information

- **Practice address:** 1233 SOUTHWEST AVE EXT, JOHNSON CITY, TN 37604
- **Practice address phone:** (423) 979-3200
- **Practice address fax:** (423) 979-3267
- **Mailing address:** 1233 SOUTHWEST AVE EXT, JOHNSON CITY, TN 37604
- **Mailing address phone:** (423) 979-3200
- **Mailing address fax:** (423) 979-3267

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/06/2005
- **Last updated:** 08/22/2020