Organization
STATE OF TENNESSEE
Active
Other names
NE Tennessee Mobil Dental Unit
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FRED ADANS (REGIONAL DIRECTOR)
(423) 979-3200
Entity
Organization
Contact information
Practice address
1233 SOUTHWEST AVE. EXT., JOHNSON CITY, TN 37604
(423) 979-3200
(423) 979-3267
Mailing address
1233 SOUTHWEST AVE. EXT., JOHNSON CITY, TN 37604
(423) 979-3200
(423) 979-3267
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Enumeration date
02/12/2007
Last updated
08/22/2020
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