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Organization
BOONES CREEK DENTISTRY
Active
Organization
BOONES CREEK DENTISTRY
Active
Other names
Boones Creek Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA GAIL ANDREWS (ADMINISTRATIVE ASSISTANT)
(423) 282-2441
Entity
Organization
Contact information
Practice address
4328 N ROAN ST, JOHNSON CITY, TN 37615-4641
(423) 282-2441
Mailing address
4328 N ROAN ST, JOHNSON CITY, TN 37615-4641
(423) 282-2441
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1255828356
DENTAL
TN
01
—
1326185471
DENTAL
TN
01
—
1568812691
DENTAL
TN
Enumeration date
02/22/2023
Last updated
02/22/2023
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