Provider Demographics
NPI:1881142859
Name:JOHN A. MASENGILL, DDS, PLLC
Entity type:Organization
Organization Name:JOHN A. MASENGILL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:MASENGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-356-6929
Mailing Address - Street 1:127 W MACON LN
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4776
Mailing Address - Country:US
Mailing Address - Phone:865-573-7330
Mailing Address - Fax:
Practice Address - Street 1:127 W MACON LN
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4776
Practice Address - Country:US
Practice Address - Phone:865-573-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS9638122300000X
TNDS8691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty