Provence and Haley, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS4607 Issued in TN

Legal business name

PROVENCE AND HALEY, PC

Practice address

502 E College St
Dickson, TN 37055-2016

Phone

(615) 446-9669

Fax

(615) 446-9661

NPI assigned

May 18, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Mina H Harris

Title

Office Manager

Phone

(615) 419-1943

Specialties & licenses 2

Addresses

Other identifiers 8

Other names 1

• Tennessee Oral & Maxillofacial Surgeons Other name

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy D Provence, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Nashville, TN
  • NPI 1982601829
  NPD (past)
• Jeffrey Lewis Culbreath, D.D.S.

  • Dentist
  • Portsmouth, VA
  • NPI 1780821199
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1242604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242604800000",
    "number": "1033344288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4322 HARDING PIKE",
            "address_2": "SUITE 201",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052490",
            "telephone_number": "615-829-7000",
            "fax_number": "615-829-7001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 E COLLEGE ST",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552016",
            "telephone_number": "615-446-9669",
            "fax_number": "615-446-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENCE AND HALEY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-18",
        "last_updated": "2009-05-18",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MINA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-419-1943",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS4607",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS7219",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "4607",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "2006315",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "7219",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275531972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1982601829",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "3141185",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "667954",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "918666",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennessee Oral & Maxillofacial Surgeons",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Charles Lee Preston, D.D.S
• Allison Marie Price, LMHP
• Michael Norman Price, B.S.
• Deborah Gray Prichard
• Lisa Michelle Pritchard, BS
• Barbara A. Pruitt, RN
• Psychiatric Care and Consulting LLC
• Elizabeth Stokes Pulliam, MS OTR/L
• Nancy L Pullias, LCSW
• Pulmonary & Sleep Specialists PLC

• Oral and Maxillofacial Surgery (Dentist) in Dickson, TN
• Providers in Dickson, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.