DR. SANDFORD W PRINCE (NPI# 1790750586) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790750586 |
| Entity Type | Individual |
| Full Name | DR. SANDFORD W PRINCE |
| Other Name | MR. SANFORD PRINCE |
| Credential | DMD |
| Practice Address |
2306 Knob Creek Road #108 Knob Creek Oral Clinic Johnson City TN 37604 |
| Practice Telephone | 4234675009 |
| Practice Fax Number | 4234675009 |
| Mailing Telephone | 4234675009 |
| Mailing Fax Number | 4234675009 |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-04-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DS0000009647 | TN | Dental Providers |
| N | 261QS0112X |
Clinic/Center Specialization: Oral and Maxillofacial Surgery |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | TENNESSEE | 465705259 | 01 |
| TN | DEA | FP1869506 | 01 |
| TN | CAQH | 12683544 | 01 |
| Street Address |
2306 KNOB CREEK ROAD #108 KNOB CREEK ORAL CLINIC |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| 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 |
|---|---|---|---|---|
| 1295898286 | James Leonard Desantis | Dentist | 535 Columbia Drive, Johnson City, NY 13790 | 2006-12-19 |
| 1104812213 | Martin R Pittman Dds Ms PC | Dentist | 111 W Fairview Ave, Johnson City, TN 37604-5632 | 2005-09-23 |
| 1295736569 | Carl W Eilers Jr. | Dentist | 508 Princeton Rd, Suite 204, Johnson City, TN 37601-2060 | 2005-08-09 |
| 1427163666 | The Regional Center for Oral & Maxillofacial Surgery, PC | Dentist | 1021 W Oakland Ave, Suite 109, Johnson City, TN 37604-2191 | 2006-08-20 |
| 1588634471 | Charles Edward Witkowski Sr. | Dentist | 1021 W Oakland Ave, Suite 109, Johnson City, TN 37604-2191 | 2006-01-24 |
| 1518969229 | L Alan Bacon Dds PC & John Collins Dds PC | Dentist | 508 Princeton Rd, Suite 204, Johnson City, TN 37601-2060 | 2005-08-12 |
| 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 | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on DR. SANDFORD W PRINCE.
| 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.