Knob Creek Oral Clinic

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

DS0000009647 Issued in TN

Legal business name

KNOB CREEK ORAL CLINIC

Practice address

2306 Knob Creek Rd
Suite 108
Johnson City, TN 37604-2366

Phone

(423) 467-5009

NPI assigned

Apr 21, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Sandford W Prince, DMDNPI 1790750586

Title

Oral Surgeon

Phone

(423) 467-5010

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.

• Sandford W Prince, DMD

  • Oral and Maxillofacial Surgery (Dentist)
  • Johnson City, TN
  • NPI 1790750586

  Oral and Maxillofacial Surgery

  NPD (past) Authorized official

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429574400000",
    "number": "1497142137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 KNOB CREEK RD",
            "address_2": "SUITE 108",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042366",
            "telephone_number": "423-467-5009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 KNOB CREEK RD",
            "address_2": "SUITE 108",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042366",
            "telephone_number": "423-467-5009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNOB CREEK ORAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-21",
        "last_updated": "2015-04-21",
        "status": "A",
        "authorized_official_last_name": "PRINCE",
        "authorized_official_first_name": "SANDFORD",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ORAL SURGEON",
        "authorized_official_telephone_number": "423-467-5010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS0000009647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lance A Klosterman, M.D.
• David Andrew Knechtel, PA
• Rachel Joan Knierim
• Kenneth Michael Knight, CPRS
• Joseph R Knisley
• Knob Creek Physical Therapy LLC
• Lester G Koe Jr., DDS
• Tammy Williams Koen, MS, CCC-SLP
• Russell David Koesters, PA
• Suzanne M Koett

• All providers in Johnson City, TN
• Oral and Maxillofacial Surgery Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; 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.