Provider Demographics
NPI:1114980349
Name:PAFFRATH, JOHN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:PAFFRATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4889 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-4115
Mailing Address - Country:US
Mailing Address - Phone:931-289-4228
Mailing Address - Fax:931-289-5832
Practice Address - Street 1:4889 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-4115
Practice Address - Country:US
Practice Address - Phone:931-289-4228
Practice Address - Fax:931-289-5832
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS42161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224979Medicaid