Provider Demographics
NPI:1972504389
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 1:117 W SEVIER AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3799
Mailing Address - Country:US
Mailing Address - Phone:423-224-3200
Mailing Address - Fax:423-224-3208
Practice Address - Street 1:117 W SEVIER AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3799
Practice Address - Country:US
Practice Address - Phone:423-224-3200
Practice Address - Fax:423-224-3208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
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
TN1154322451OtherMICHAEL L HAMLIN IND. NPI
TN1295736304OtherL ALAN BACON IND. NPI
TN1023019254OtherJOHN R COLLINS IND. NPI
TN1295736569OtherCARL W EILERS, JR IND NPI
TN1023019254OtherJOHN R COLLINS IND. NPI
TN3726194Medicare PIN
TN1295736304OtherL ALAN BACON IND. NPI
TN3225274Medicare PIN
TN3218775Medicare PIN