# MISTY HORN-BLAKE D.D.S PC

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

## Provider details

- **NPI number:** 1588831275
- **Authorized official:** MRS. MISTY R HORN-BLAKE D.D.S (OWNER/DOCTOR)
- **Authorized official phone:** (423) 283-8830

## Contact information

- **Practice address:** 1301 SUNSET DR, SUITE 6, JOHNSON CITY, TN 37604-7906
- **Practice address phone:** (423) 283-8830
- **Practice address fax:** (423) 283-8820
- **Mailing address:** 1301 SUNSET DR, SUITE 6, JOHNSON CITY, TN 37604-7906
- **Mailing address phone:** (423) 283-8830
- **Mailing address fax:** (423) 283-8820

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 8728 | TN | Yes |

## Other

- **Enumeration date:** 05/12/2008
- **Last updated:** 05/12/2008