Provider Demographics
NPI:1831265487
Name:CADE, ALISA A (DDS)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:A
Last Name:CADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SYLVAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663
Mailing Address - Country:US
Mailing Address - Phone:423-239-9997
Mailing Address - Fax:
Practice Address - Street 1:185 TREASURE LANE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6519
Practice Address - Country:US
Practice Address - Phone:423-979-3200
Practice Address - Fax:423-979-3267
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0006963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000925Medicaid