Provider Demographics
NPI:1467868471
Name:AFFORDABLE EXTRACTIONS
Entity Type:Organization
Organization Name:AFFORDABLE EXTRACTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, FAGD
Authorized Official - Phone:423-232-7343
Mailing Address - Street 1:300 W WATAUGA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5549
Mailing Address - Country:US
Mailing Address - Phone:423-232-7343
Mailing Address - Fax:423-232-7337
Practice Address - Street 1:300 W WATAUGA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5549
Practice Address - Country:US
Practice Address - Phone:423-232-7343
Practice Address - Fax:423-232-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7771122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty