Healthcare Provider Details

I. General information

NPI: 1134843436
Provider Name (Legal Business Name): HERMITAGE ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 BRANDYWINE VILLAGE CT
OLD HICKORY TN
37138-2122
US

IV. Provider business mailing address

616 BRANDYWINE VILLAGE CT
OLD HICKORY TN
37138-2122
US

V. Phone/Fax

Practice location:
  • Phone: 615-883-0067
  • Fax: 615-883-0365
Mailing address:
  • Phone: 615-883-0067
  • Fax: 615-883-0365

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. ABIGAIL YAZBAK
Title or Position: DMD/OWNER
Credential: DMD
Phone: 615-883-0067