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General NPI Number Information
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NPI Number | 1558528570
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE ORAL & MAXILLOFACIAL SURGERY
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 308 E LINCOLN ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-3750
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Country | US
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Telephone | 931-455-3385
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Fax | 931-455-1865
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Provider Business Mailing Address
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Address Line | 308 E LINCOLN ST
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City | TULLAHOMA
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State | TN
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Zip | 37388-3750
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Country | US
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Telephone | 931-455-3385
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Fax | 931-455-1865
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARK F HARDISON
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Credential | DDS
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Telephone | 615-893-7736
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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 | DS7248
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License Number State | TN
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