Provider Demographics
NPI:1437658507
Name:ADVANCED DENTAL AND ANESTHESIA SOLUTIONS LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL AND ANESTHESIA SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:423-483-0945
Mailing Address - Street 1:PO BOX 5610
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-5610
Mailing Address - Country:US
Mailing Address - Phone:423-483-0945
Mailing Address - Fax:
Practice Address - Street 1:135 MARKETPLACE DR STE 101
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8933
Practice Address - Country:US
Practice Address - Phone:423-483-0945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty