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General NPI Number Information
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NPI Number | 1659546455
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Entity Type | Organization
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Legal Business Name | MIDDLE TENNESSEE ORAL SURGERY CENTER
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 1801 CHURCH ST
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City | NASHVILLE
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State | TN
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Zip | 37203-2201
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Country | US
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Telephone | 615-327-2626
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Fax | 615-327-2607
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Provider Business Mailing Address
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Address Line | PO BOX 2162
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City | BRENTWOOD
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State | TN
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Zip | 37024-2162
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Country | US
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Telephone | 615-327-2626
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Fax | 615-327-2607
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS NOMA GWEBU
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Credential | B.S
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Telephone | 615-327-2626
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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 | 8035
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License Number State | TN
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