Provider Demographics
NPI:1700303922
Name:APPALACHIAN DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:APPALACHIAN DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-247-7741
Mailing Address - Street 1:550 BALLARDS PRIVATE DR
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5200
Mailing Address - Country:US
Mailing Address - Phone:423-323-2967
Mailing Address - Fax:
Practice Address - Street 1:613 WATAUGA ST
Practice Address - Street 2:STE C, D, & E
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4429
Practice Address - Country:US
Practice Address - Phone:423-247-7741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty