# BOONES CREEK DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Boones Creek Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124726724
- **Authorized official:** MELISSA GAIL ANDREWS (ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (423) 282-2441

## Contact information

- **Practice address:** 4328 N ROAN ST, JOHNSON CITY, TN 37615-4641
- **Practice address phone:** (423) 282-2441
- **Mailing address:** 4328 N ROAN ST, JOHNSON CITY, TN 37615-4641
- **Mailing address phone:** (423) 282-2441

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 02/22/2023
- **Last updated:** 02/22/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1255828356 | DENTAL | TN |
| 01 | — | 1326185471 | DENTAL | TN |
| 01 | — | 1568812691 | DENTAL | TN |