Provider Demographics
NPI:1356491666
Name:PRYSE,JR., JOHN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:PRYSE,JR.
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 1:180 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-2817
Mailing Address - Country:US
Mailing Address - Phone:865-457-2299
Mailing Address - Fax:865-463-8223
Practice Address - Street 1:180 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-2817
Practice Address - Country:US
Practice Address - Phone:865-457-2299
Practice Address - Fax:865-463-8223
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics