Larry Alan Bacon, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS2171 Issued in TN

Practice address

117 W Sevier Ave
Suite 220
Kingsport, TN 37660-3799

Phone

(423) 224-3200

NPI assigned

Aug 10, 2005

Last updated

Mar 1, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Dr. L Alan Bacon Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• L Alan Bacon DDS PC & John Collins DDS PC

  dba Associated Oral and Maxillofacial Surgeons

  • Oral and Maxillofacial Surgery (Dentist)
  • Johnson City, TN
  • NPI 1518969229
  NPD (past)

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1295736304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 W SEVIER AVE",
            "address_2": "SUITE 220",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603799",
            "telephone_number": "423-224-3200",
            "fax_number": "423-224-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 W SEVIER AVE",
            "address_2": "SUITE 220",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603799",
            "telephone_number": "423-224-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "LARRY",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS2171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "3726194",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPI",
            "identifier": "1609878388",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPI",
            "identifier": "1518969229",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORGANIZATION NPI",
            "identifier": "1972504389",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "L",
            "last_name": "BACON",
            "middle_name": "ALAN",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Bradley S Avans, CRNA
• Joseph Barron Avery, MD
• Mary Axelrad, MD
• Mark Aziz, MD
• Kathryn Backus, NP
• Michael L Bacon, MD
• Claxton Allen Baer, M.D.
• Beverly Lynn Bailey, MS,CCC-SLP
• Courtney Bailey
• Heather Bailey, PHARM.D

• Oral and Maxillofacial Surgery (Dentist) in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.