Cumberland Gap Orthodontics

NPI #1669459251 in Harrogate, Tennessee

Provider Information

NPI Number: 1669459251
Entity Type: Organization
Organization Name: Cumberland Gap Orthodontics
Primary Specialty: Dentist - Orthodontics and Dentofacial Orthopedics
Enumeration Date: Dec 27, 2005
Last Updated: Mar 17, 2008

Practice Location

Address: 119 WESTMORELAND ST
City: Harrogate
State: Tennessee
ZIP Code: 37752-8202
Phone: (423) 869-5719

Authorized Official

Name: DR. JESSE BURTON DOUGLASS JR., DMD MSD
Title: CEO AND PRESIDENT
Phone: (423) 869-5719

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Orthodontics and Dentofacial Orthopedics — Orthodontics and Dentofacial Orthopedics	1223X0400X	Primary

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