=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710955471
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORAL AND MAXILLOFACIAL SURGERY AFFILATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1909 MALLORY LN SUITE 100
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-771-1983
-----------------------------------------------------
Fax | 615-771-2432
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1909 MALLORY LN SUITE 100
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-771-1983
-----------------------------------------------------
Fax | 615-771-2432
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. ANTHONY P URBANEK
-----------------------------------------------------
Credential | D.D.S. , M.D.
-----------------------------------------------------
Telephone | 615-771-1983
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204E00000X
-----------------------------------------------------
Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------