Provider Demographics
NPI:1255997359
Name:JOHNSON CITY SMILES, LLC
Entity type:Organization
Organization Name:JOHNSON CITY SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAMRON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:423-928-0345
Mailing Address - Street 1:2800 PEOPLES ST STE 90
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4158
Mailing Address - Country:US
Mailing Address - Phone:423-928-0345
Mailing Address - Fax:423-926-4358
Practice Address - Street 1:2800 PEOPLES ST STE 90
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4158
Practice Address - Country:US
Practice Address - Phone:423-928-0345
Practice Address - Fax:423-926-4358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty