CUMBERLAND GAP ORTHODONTICS (NPI# 1669459251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669459251 |
| Entity Type | Organization |
| Organization Name | CUMBERLAND GAP ORTHODONTICS |
| Practice Address |
119 Westmoreland St Harrogate TN 37752-8202 |
| Mailing Address |
Po Box 15 Harrogate TN 37752-0015 |
| Practice Telephone | 4238695719 |
| Practice Fax Number | 4238695749 |
| Mailing Telephone | 4238695719 |
| Mailing Fax Number | 4238695749 |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2008-03-17 |
| Authorized Official Name | DR. JESSE BURTON DOUGLASS JR. (CEO AND PRESIDENT) |
| Authorized Official Telephone | 4238695719 |
| Authorized Official Credential | DMD MSD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 013672 | 05 | |
| KY | 60042058 | 05 |
| Street Address |
119 WESTMORELAND ST |
| City | HARROGATE |
| State | TN |
| Zip Code | 37752-8202 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295281145 | Tracie Herrell | Nurse Practitioner | 159 Piccadilly Ave, Harrogate, TN 37752 | 2016-08-31 |
| 1245535715 | Julianne Christine Ray | Physician Assistant | 6965 Cumberland Gap Parkway, Lincoln Memorial University, Harrogate, TN 37752 | 2011-01-14 |
| 1003975392 | Psychiatric Practice,llc | Psychiatry & Neurology | 6144 Cumberland Gap Pkway, Suite 1, Harrogate, TN 37752 | 2006-12-06 |
| 1922180991 | Debbie A Poore | Nurse Practitioner | 169 Westmoreland St, Harrogate, TN 37752 | 2006-10-19 |
| 1306938352 | Hearland Medical P C | Family Medicine | 170 Beech Street, Suite 1, Harrogate, TN 37752 | 2006-09-28 |
| 1790889475 | Nancy Deane Good Maddox | Psychologist | 6144 Cumberland Gap Parkway, Suite 2, Harrogate, TN 37752 | 2006-09-12 |
| 1710913090 | Gina Marie Defranco | Family Medicine | 424 N. Broad Street, New Tazewell, TN 37752 | 2006-06-25 |
| 1497792253 | Kenneth P Trzil | Emergency Medicine | 165 Westermoreland St, Harrogate, TN 37752 | 2006-06-01 |
| 1831164862 | Ramesh Kadekoppal Rao | Radiology | 389 Forge Ridge Road, Harrogate, TN 37752 | 2006-02-22 |
| 1447867080 | Evgenia Pavlovna Suttles | Registered Nurse | 6965 Cumberland Gap Pkwy, Harrogate, TN 37752 | 2020-09-28 |
| Find all providers in zip 37752 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013523703 | Evan James Agnetta | Dentist | 6311 Kingston Pike Ste 26w, Knoxville, TN 37919-4900 | 2020-09-18 |
| 1619595618 | Allison Jerri Williams | Dentist | 801 Sunset Dr # E5, Johnson City, TN 37604-3033 | 2020-07-07 |
| 1396369054 | John Thomas Houston Iv | Dentist | 125 Cool Springs Blvd # 140, Franklin, TN 37067-6474 | 2020-05-28 |
| 1407499957 | Kevin Michael Peterson | Dentist | 1607 Westgate Cir Ste 400, Brentwood, TN 37027-8080 | 2019-10-28 |
| 1306488622 | Cumberland Pediatric Dentistry and Orthodontics of Cool Springs, Pllc | Dentist | 1201 Liberty Pike, Suite 202-b, Franklin, TN 37067 | 2019-10-09 |
| 1285191767 | Mh Dmd of Tennessee, Pllc | Dentist | 2126 Abbott Martin Rd Ste 168, Nashville, TN 37215-2619 | 2019-02-21 |
| 1245713528 | Lucas Orthodontics Gallatin, Pllc | Dentist | 1710 Nashville Pike, Gallatin, TN 37066-3154 | 2018-09-12 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1902329097 | Carmen Allie Quirk | Dentist | 755 E Veterans Dr, Cookeville, TN 38501-5194 | 2017-07-20 |
| 1568996999 | Jefferson Twomley | Dentist | 1414 Jenkins Rd Ste 146, Chattanooga, TN 37421-3470 | 2017-04-12 |
| 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.