Provider Demographics
NPI:1225350267
Name:STARTUP, JOHN DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DANIEL
Last Name:STARTUP
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:PO BOX 127
Mailing Address - Street 2:19 WEST NORRIS RD
Mailing Address - City:NORRIS
Mailing Address - State:TN
Mailing Address - Zip Code:37828-0127
Mailing Address - Country:US
Mailing Address - Phone:865-494-7030
Mailing Address - Fax:865-494-9571
Practice Address - Street 1:19 WEST NORRIS RD
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828-0127
Practice Address - Country:US
Practice Address - Phone:865-494-7030
Practice Address - Fax:865-494-9571
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND54450122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist