Vista Ridge Dental Arts Studio, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

10324 Issued in TN

Legal business name

VISTA RIDGE DENTAL ARTS STUDIO, LLC

Practice address

108 W 10TH Ave
Johnson City, TN 37604-3800

Phone

(423) 979-1800

Fax

(423) 979-1802

NPI assigned

Dec 27, 2017

Last updated

Dec 27, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Amy Herron Moody, DDSNPI 1366996084

Title

Dentist/Sole MBR

Phone

(804) 979-1800

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Amy Herron Moody, DDS

  • Dentist
  • Johnson City, TN
  • NPI 1366996084
  NPD Authorized official

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514332800000",
    "number": "1154837292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 W 10TH AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043800",
            "telephone_number": "423-979-1800",
            "fax_number": "423-979-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W 10TH AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376043800",
            "telephone_number": "423-979-1800",
            "fax_number": "423-979-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA RIDGE DENTAL ARTS STUDIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-27",
        "last_updated": "2017-12-27",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "HERRON",
        "authorized_official_title_or_position": "DENTIST/SOLE MBR",
        "authorized_official_telephone_number": "804-979-1800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TN",
            "license": "10324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachael Marie Vines, BS
• Elizabeth M. Virost, FNP
• Kevin Charles Visconti, M.D.
• Krystal Jo Visser, BSW
• Vista Recovery Systems, Inc
• Glynetta Shepherd Vogt, OD
• Brooklyn Volkman, FNP-C
• Tiona Von Almen, COTA/L
• Shane D. Vore, PMHNP-BC
• Autum Wade

• Dental Clinic/Center in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Dental Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2017; 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.