Larry Alan Bacon, DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Kingsport, TN
NPI 1295736304 · NPPES record last updated Mar 1, 2012
Key facts
- NPI
- 1295736304
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- DS2171 (TN)
- Practice address
- 117 W Sevier Ave
Suite 220
Kingsport, TN 37660-3799 - Phone
- (423) 224-3200
- NPI assigned
- Aug 10, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS2171 | TN | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| L Alan Bacon DDS PC & John Collins DDS PC | Oral and Maxillofacial Surgery | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | DS2171 | TN | Yes |
Addresses
Primary practice location
117 W Sevier Ave
Suite 220
Kingsport, TN 37660-3799
Mailing address
117 W Sevier Ave
Suite 220
Kingsport, TN 37660-3799
Phone (423) 224-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609878388 | Other | TN | ORGANIZATION NPI |
| 3726194 | Other | TN | MEDICARE GROUP NUMBER |
| 1518969229 | Other | TN | ORGANIZATION NPI |
| 1972504389 | Other | ORGANIZATION NPI |
Other names
- Dr. L Alan Bacon
Other providers in Kingsport, TN
- Bradley S Avans
- Joseph Barron Avery
- Mary Axelrad
- Mark Aziz
- Kathryn Backus
- Michael L Bacon
- Claxton Allen Baer
- Beverly Lynn Bailey
- Heather Bailey
- Lauren Buchanan Bailey
All providers in Kingsport, TN · Oral and Maxillofacial Surgery (Dentist) in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.