Organization
DAYSPRING HEALTH INC
Active
Other names
Dayspring Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DAVID HARRIS (CREDENTIALING)
(423) 784-8492
Entity
Organization
Contact information
Practice address
640 W HIGHWAY 92 STE 3, WILLIAMSBURG, KY 40769-1936
(606) 765-6080
(606) 549-2855
Mailing address
PO BOX 540, JELLICO, TN 37762-0540
(423) 784-8492
(423) 455-0380
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10107
STATE LICENSE
KY
05
—
31000946
—
KY
05
—
7100191350
—
KY
05
—
7100553680
—
KY
01
—
9042
STATE LICENSE
KY
05
—
Q055857
—
TN
Enumeration date
01/18/2019
Last updated
09/20/2023
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