# HOUSE MOUNTAIN DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** House Mountain Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558957159
- **Authorized official:** DEBBIE M LONG RDH (OFFICE MANAGER)
- **Authorized official phone:** (865) 992-5821

## Contact information

- **Practice address:** 3802 MAYNARDVILLE HWY, MAYNARDVILLE, TN 37807-3413
- **Practice address phone:** (865) 992-5821
- **Practice address fax:** (865) 992-3042
- **Mailing address:** 3802 MAYNARDVILLE HWY, MAYNARDVILLE, TN 37807-3413
- **Mailing address phone:** (865) 992-5821
- **Mailing address fax:** (865) 992-3042

## Taxonomy

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

## Other

- **Enumeration date:** 12/17/2020
- **Last updated:** 12/17/2020