NPIMap

Individual provider Active NPI

Douglas Clayton Mullins II, D.D.S.

  • General Practice Dentistry
  • Kingsport, TN
National Provider Identifier
1083767784
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS-6820 Issued in TN
Practice address
613 Watauga St
Ste C, D, & E
Kingsport, TN 37660-4429
Phone
(423) 247-7741
Fax
(423) 247-7441
NPI assigned
Jan 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS-6820 TN Primary

Addresses

Primary practice location

613 Watauga St
Ste C, D, & E
Kingsport, TN 37660-4429

Mailing address

550 Ballards Private Drive
Blountville, TN 37617
Phone (423) 323-2967

Other identifiers 3

IdentifierTypeStateIssuer
9181319MedicaidTN
5440717MedicaidTN
148129OtherTNBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DS-6820TNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Appalachian Dental Group PLLC General Practice CurrentSince Jul 24, 2022 Accepting new patients
Tennessee Dental Health Services PLLC PastSince Jul 24, 2022 Accepting new patients
Watauga Dental Center, PLLC General Practice Past Accepting new patients

Locations

613 Watauga St
Ste C
Kingsport, TN 37660
Phone (423) 247-7741

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083767784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 BALLARDS PRIVATE DRIVE",
            "city": "BLOUNTVILLE",
            "state": "TN",
            "postal_code": "37617",
            "telephone_number": "423-323-2967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 WATAUGA ST",
            "address_2": "STE C, D, & E",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604429",
            "telephone_number": "423-247-7741",
            "fax_number": "423-247-7441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "DOUGLAS",
        "middle_name": "CLAYTON",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS-6820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9181319",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5440717",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "148129",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.