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General NPI Number Information
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NPI Number | 1033344288
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Entity Type | Organization
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Legal Business Name | PROVENCE AND HALEY, PC
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 502 E COLLEGE ST
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City | DICKSON
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State | TN
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Zip | 37055-2016
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Country | US
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Telephone | 615-446-9669
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Fax | 615-446-9661
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Provider Business Mailing Address
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Address Line | 4322 HARDING PIKE SUITE 201
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City | NASHVILLE
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State | TN
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Zip | 37205-2490
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Country | US
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Telephone | 615-829-7000
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Fax | 615-829-7001
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MINA H HARRIS
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Credential |
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Telephone | 615-419-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS7219
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS4607
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License Number State | TN
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