Southeast Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

SOUTHEAST ORAL SURGERY PC

Practice address

1858 Crest Rd
Maryville, TN 37804-4305

Phone

(865) 977-7110

Fax

(865) 977-4132

NPI assigned

Aug 30, 2006

Last updated

Apr 15, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Timothy P McConnell, DDSNPI 1821071341

Title

Ceo

Phone

(865) 977-7110

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Timothy P McConnell, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1821071341
  Authorized official Same address or phone
• Jason Robert Kennedy, D.M.D.

  • Oral and Maxillofacial Surgery (Dentist)
  • Rocky Top, TN
  • NPI 1518151935
  NPD (past)
• Mitchell Ryan Mascaro, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Knoxville, TN
  • NPI 1356837322
  NPD (past)
• Garren M Petree, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Maryville, TN
  • NPI 1487941605
  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239753600000",
    "number": "1184733446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1858 CREST RD",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044305",
            "telephone_number": "865-977-7110",
            "fax_number": "865-977-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1858 CREST RD",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044305",
            "telephone_number": "865-977-7110",
            "fax_number": "865-977-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2009-04-15",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "865-977-7110",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lewis C Sommerville, MD
• Christy Sorrell, PH.D.
• Michael Sousa-Johnson, MS, LAT, ATC
• Terry L South, NP-C
• Southeast Mobile Smiles
• Susan Souther, M.D.
• Southern Orthocare Inc
• Southland Health Services, LLC
• Kimberly Sparkman
• Paula S Sparkman, FNP

• Oral and Maxillofacial Surgery (Dentist) in Maryville, TN
• Providers in Maryville, 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 Apr 15, 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.