Provider Demographics
NPI:1114921178
Name:APPALACHIAN LIFE QUALITY INITISTIVE
Entity Type:Organization
Organization Name:APPALACHIAN LIFE QUALITY INITISTIVE
Other - Org Name:SCOTT COUNTY DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-663-8200
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37756-0210
Mailing Address - Country:US
Mailing Address - Phone:423-663-8200
Mailing Address - Fax:423-663-8544
Practice Address - Street 1:350 COURT STREET
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37756
Practice Address - Country:US
Practice Address - Phone:423-663-8200
Practice Address - Fax:423-663-8544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty