Healthcare Provider Details

I. General information

NPI: 1679729016
Provider Name (Legal Business Name): HARRY R. MACK, JR., D.D.S., M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 06/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 NOLENSVILLE PIKE SUITE 103
NASHVILLE TN
37211-6520
US

IV. Provider business mailing address

5802 NOLENSVILLE PIKE SUITE 103
NASHVILLE TN
37211-6520
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-5599
  • Fax: 615-834-4579
Mailing address:
  • Phone: 615-873-4495
  • Fax: 615-873-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TRACY FLOWERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 615-873-4495