Cumberland Gap Orthodontics

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

CUMBERLAND GAP ORTHODONTICS

Practice address

119 Westmoreland St
Harrogate, TN 37752-8202

Phone

(423) 869-5719

Fax

(423) 869-5749

NPI assigned

Dec 27, 2005

Last updated

Mar 17, 2008By 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. Jesse Burton Douglass Jr., DMD MSD

Title

Ceo and President

Phone

(423) 869-5719

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1669459251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377520015",
            "telephone_number": "423-869-5719",
            "fax_number": "423-869-5749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 WESTMORELAND ST",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528202",
            "telephone_number": "423-869-5719",
            "fax_number": "423-869-5749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUMBERLAND GAP ORTHODONTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-27",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS",
        "authorized_official_first_name": "JESSE",
        "authorized_official_middle_name": "BURTON",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "423-869-5719",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DMD MSD"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60042058",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013672",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Nichole Clotfelter, PA-C
• Marcus Fayne Cole Jr.
• Lauren Contreras, PA-C
• Luke Anthony Cooper
• Ellen Cottrell
• Cumberland Gap Transport
• Mariela Chantel Davis
• Bethany Ann Doles
• Family Medical Clinic of Harrogate, P.C.
• Lexi Fleming

• Orthodontics and Dentofacial Orthopedics Dentistry in Harrogate, TN
• Providers in Harrogate, TN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.