Provider Demographics
NPI:1609878388
Name:L ALAN BACON DDS PC & JOHN COLLINS DDS PC
Entity Type:Organization
Organization Name:L ALAN BACON DDS PC & JOHN COLLINS DDS PC
Other - Org Name:ASSOCIATED ORAL AND MAXILLOFACIAL SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-224-3200
Mailing Address - Street 1:1 MEDICAL PARK BLVD
Mailing Address - Street 2:SUITE 440 EAST
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7430
Mailing Address - Country:US
Mailing Address - Phone:423-844-6200
Mailing Address - Fax:423-844-4730
Practice Address - Street 1:1 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 440 EAST
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7430
Practice Address - Country:US
Practice Address - Phone:423-844-6200
Practice Address - Fax:423-844-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1295736569OtherCARL W EILERS, JR IND NPI
TN1295736304OtherL ALAN BACON IND. NPI
TN1023019254OtherJOHN R COLLINS IND NPI
TN1154322451OtherMICHAEL L HAMLIN IND. NPI
TN3218775Medicare PIN
TN3726194Medicare PIN
TN3205528Medicare PIN
TN1295736304OtherL ALAN BACON IND. NPI
TN1295736569OtherCARL W EILERS, JR IND NPI