NPIMap

Organization Active NPI

Universal Dental Assoc Dso LLC

  • Dentist
  • Johnson City, TN
National Provider Identifier
1467758227
Registry record updated Aug 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS3637 Issued in TN
Legal business name
UNIVERSAL DENTAL ASSOC DSO LLC
Practice address
712 W Walnut St
Johnson City, TN 37604-6524
Phone
(423) 928-5500
Fax
(423) 929-1505
NPI assigned
Jan 26, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2013

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

Authorized official

Name
Tonya Lynn Langenbrunner
Title
Office Manager
Phone
(423) 928-5500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DS3637 TN Primary

Addresses

Primary practice location

712 W Walnut St
Johnson City, TN 37604-6524

Mailing address

712 W Walnut St
Johnson City, TN 37604-6524
Phone (423) 928-5500

Other identifiers 2

IdentifierTypeStateIssuer
3225187MedicaidTN
12211029OtherTNCAQH

Other names 1

  • university dental assoc Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375315200000",
    "number": "1467758227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "712 W WALNUT ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046524",
            "telephone_number": "423-928-5500",
            "fax_number": "423-929-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 W WALNUT ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046524",
            "telephone_number": "423-928-5500",
            "fax_number": "423-929-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSAL DENTAL ASSOC DSO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-26",
        "last_updated": "2013-08-01",
        "status": "A",
        "authorized_official_last_name": "LANGENBRUNNER",
        "authorized_official_first_name": "TONYA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "423-928-5500"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "DS3637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3225187",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12211029",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "university dental assoc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2013; 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.