Healthcare Provider Details

I. General information

NPI: 1356414189
Provider Name (Legal Business Name): ORAL & MAXILLOFACIAL SURGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LABORATORY RD
OAK RIDGE TN
37830-6802
US

IV. Provider business mailing address

420 LABORATORY RD
OAK RIDGE TN
37830-6802
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-1319
  • Fax: 865-481-3067
Mailing address:
  • Phone: 865-482-1319
  • Fax: 865-481-3067

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: DR. BRETT JAFFREY
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 865-482-1319