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General NPI Number Information
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NPI Number | 1609432368
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Entity Type | Organization
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Legal Business Name | TRACE ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 05/17/2019
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Last Update Date | 05/17/2019
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Provider Practice Location Address
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Address Line | 7146 NOLENSVILLE RD
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City | NOLENSVILLE
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State | TN
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Zip | 37135-9585
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Country | US
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Telephone | 615-776-3442
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Fax |
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Provider Business Mailing Address
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Address Line | 7004 MOORES LN
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City | BRENTWOOD
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State | TN
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Zip | 37027-2905
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Country | US
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Telephone | 615-377-7777
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JONATHAN LUCAS
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Credential |
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Telephone | 615-377-7777
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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 |
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License Number State |
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