Provider Demographics
NPI:1558366716
Name:DWIGHT A DEBOW DDS PC
Entity Type:Organization
Organization Name:DWIGHT A DEBOW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST - ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:423-247-5137
Mailing Address - Street 1:1203 N WILCOX DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4971
Mailing Address - Country:US
Mailing Address - Phone:423-247-5137
Mailing Address - Fax:
Practice Address - Street 1:1203 N WILCOX DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4971
Practice Address - Country:US
Practice Address - Phone:423-247-5137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 2129261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental