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General NPI Number Information
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NPI Number | 1851412811
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Entity Type | Organization
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Legal Business Name | COOPER, PROVENCE & HALEY, PC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 207 23RD AVE N
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City | NASHVILLE
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State | TN
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Zip | 37203-1501
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Country | US
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Telephone | 615-320-1392
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Fax | 615-329-4245
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Provider Business Mailing 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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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. SPENCER A HALEY
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Credential | DDS
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Telephone | 615-320-1392
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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 | DS3032
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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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Taxonomy #3
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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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