Healthcare Provider Details

I. General information

NPI: 1477635324
Provider Name (Legal Business Name): ORAL & FACIAL SURGERY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 20TH AVE N STE 606
NASHVILLE TN
37203-5606
US

IV. Provider business mailing address

300 20TH AVE N STE 606
NASHVILLE TN
37203-5606
US

V. Phone/Fax

Practice location:
  • Phone: 615-284-5650
  • Fax: 615-284-5653
Mailing address:
  • Phone: 615-284-5650
  • Fax: 615-284-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JOHN ROBERT WERTHER
Title or Position: PRESIDENT
Credential:
Phone: 615-284-5650