Active NPI
John Robert Popper, D.D.S.
- Prosthodontics
- Kingsport, TN
National Provider Identifier
1700979259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- DS3855
- Practice address
- 935 N Wilcox Drive
Wilcox-Sevier Professional Park Suite a
Kingsport, TN 37660 - Phone
- (423) 246-6881
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | DS3855 | TN | Primary |
Addresses
Primary practice location
935 N Wilcox Drive
Wilcox-Sevier Professional Park Suite a
Kingsport, TN 37660
Mailing address
Wilcox-Sevier Professional Park
935 N. Wilcox Drive, Suite a
Kingsport, TN 37660
Phone (423) 246-6881
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070718000520 | TN | Practitioner - Oral Surgery | 6305947532 | Practice locations: Kingsport, TN |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS3855 | TN | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1198627200000",
"number": "1700979259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "WILCOX-SEVIER PROFESSIONAL PARK",
"address_2": "935 N. WILCOX DRIVE, SUITE A",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "37660",
"telephone_number": "423-246-6881"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "935 N WILCOX DRIVE",
"address_2": "WILCOX-SEVIER PROFESSIONAL PARK SUITE A",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "37660",
"telephone_number": "423-246-6881"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POPPER",
"first_name": "JOHN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TN",
"license": "DS3855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.