Individual
DR. SANDFORD W PRINCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2306 KNOB CREEK ROAD #108, KNOB CREEK ORAL CLINIC, JOHNSON CITY, TN 37604
(423) 467-5009
(423) 467-5009
Mailing address
2306 KNOB CREEK ROAD #108, KNOB CREEK ORAL CLINIC, JOHNSON CITY, TN 37604
(423) 467-5009
(423) 467-5009
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS0000009647
TN
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12683544
CAQH
TN
01
—
465705259
TENNESSEE
TN
Enumeration date
02/23/2006
Last updated
03/07/2023
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