DR. LARRY ALAN BACON (NPI# 1295736304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295736304 |
| Entity Type | Individual |
| Full Name | DR. LARRY ALAN BACON |
| Other Name | DR. L ALAN BACON |
| Credential | DDS |
| Practice Address |
117 W Sevier Ave Suite 220 Kingsport TN 37660-3799 |
| Practice Telephone | 4232243200 |
| Mailing Telephone | 4232243200 |
| Mailing Fax Number | 4232243208 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2012-03-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DS2171 | TN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | ORGANIZATION NPI | 1518969229 | 01 |
| TN | MEDICARE GROUP NUMBER | 3726194 | 01 |
| ORGANIZATION NPI | 1972504389 | 01 | |
| TN | ORGANIZATION NPI | 1609878388 | 01 |
| Street Address |
117 W SEVIER AVE SUITE 220 |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-3799 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972504371 | Larry D Luethke | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2005-08-09 |
| 1063781714 | Sallie H Lively | Nurse Practitioner | 117 W Sevier Ave, Suite 100, Kingsport, TN 37660-3799 | 2011-12-27 |
| 1710120761 | Jason D Pickup | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2009-04-07 |
| 1922114529 | Appalachian Rehabilitation Professionals, PC | Physical Medicine & Rehabilitation | 117 W Sevier Ave, Ste 120, Kingsport, TN 37660-3799 | 2006-08-23 |
| 1962474304 | Michael David Foster | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2006-02-01 |
| 1023019254 | John R Collins | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2005-08-10 |
| 1972504389 | L Alan Bacon Dds PC & John Collins Dds PC | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2005-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972504371 | Larry D Luethke | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2005-08-09 |
| 1710120761 | Jason D Pickup | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2009-04-07 |
| 1023019254 | John R Collins | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2005-08-10 |
| 1972504389 | L Alan Bacon Dds PC & John Collins Dds PC | Dentist | 117 W Sevier Ave, Suite 220, Kingsport, TN 37660-3799 | 2005-08-09 |
| 1760486682 | Stephen Yallourakis | Dentist | 105 W Stone Dr, Ste 1a, Kingsport, TN 37660-3256 | 2005-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396199055 | Daniel Coke | Dentist | 1301 Medical Center Dr # 1601, Nashville, TN 37232-0028 | 2016-04-19 |
| 1467835140 | Amir Victor Francis | Dentist | 1100 Poplar View Ln N Ste 1, Collierville, TN 38017-9323 | 2015-06-30 |
| 1376939645 | Matthew Breit | Dentist | 1251 Wesley Dr Ste 101, Memphis, TN 38116-6442 | 2015-04-13 |
| 1720472855 | Charles Baker Felts Iv | Dentist | 901 Riverfront Pkwy Ste 202, Chattanooga, TN 37402-2193 | 2015-03-26 |
| 1073910725 | Nashville Oral Facial Surgery, Pllc | Dentist | 2400 Patterson St Ste 316, Nashville, TN 37203-6510 | 2014-11-24 |
| 1194122135 | Samuel Edward Molind | Dentist | 210 Memorial Dr, Bristol, TN 37620-1704 | 2014-11-19 |
| 1780094052 | Andrew Ferraro | Dentist | 2964 Miller Place Way, Knoxville, TN 37924-1673 | 2014-05-07 |
| 1144649393 | Thomas Bailey | Dentist | 3000 Stansberry Ln Ste 101, Franklin, TN 37069-5125 | 2014-04-15 |
| 1376962613 | John Christopher Swearingen | Dentist | 780 Ridge Lake Blvd Ste 101, Memphis, TN 38120 | 2014-04-15 |
| 1427471382 | Oral & Maxillofacial Surgery Clinic Inc. | Dentist | 910 Madison Ave Ste 710, Memphis, TN 38103-3453 | 2014-01-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.