| Cumberland Gap Orthodontics | |
|
119 Westmoreland St Harrogate TN 37752-8202 | |
| (423) 869-5719 | |
| (423) 869-5749 |
| Full Name | Cumberland Gap Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 119 Westmoreland St, Harrogate, Tennessee |
| Authorized Official Name and Position | Jesse Burton Douglass (CEO AND PRESIDENT) |
| Authorized Official Contact | 4238695719 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cumberland Gap Orthodontics Po Box 15 Harrogate TN 37752-0015 Ph: (423) 869-5719 | Cumberland Gap Orthodontics 119 Westmoreland St Harrogate TN 37752-8202 Ph: (423) 869-5719 |
| NPI Number | 1669459251 |
|---|---|
| Provider Enumeration Date | 12/27/2005 |
| Last Update Date | 03/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669459251 | NPI | - | NPPES |
| 60042058 | Medicaid | KY | |
| 013672 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
Wright And Wright Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 124 Westmoreland St, Harrogate, TN 37752 Phone: 423-869-4762 |