Healthcare Provider Details

I. General information

NPI: 1316197619
Provider Name (Legal Business Name): ANDERSON ORAL AND MAXILLOFACIAL SURGERY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FRANK PRICE BLVD
CLINTON TN
37716-1420
US

IV. Provider business mailing address

175 FRANK PRICE BLVD
CLINTON TN
37716-1420
US

V. Phone/Fax

Practice location:
  • Phone: 865-622-4959
  • Fax: 865-269-4336
Mailing address:
  • Phone: 865-622-4959
  • Fax: 865-269-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS0000005390
License Number StateTN

VIII. Authorized Official

Name: DR. JAMES GREG ANDERSON
Title or Position: OWNER
Credential: DDS
Phone: 865-209-3651