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
—
—
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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