Dickson Jaw & Facial Surgery

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS0000007915 Issued in TN

Legal business name

DICKSON JAW & FACIAL SURGERY

Practice address

445 Henslee Dr
Dickson, TN 37055-2166

Phone

(615) 441-1441

Fax

(615) 441-1460

NPI assigned

Sep 13, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Lori Ann Petty

Title

Office Manager

Phone

(615) 441-1441

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1215032438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 HENSLEE DR",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552166",
            "telephone_number": "615-441-1441",
            "fax_number": "615-441-1460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 HENSLEE DR",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552166",
            "telephone_number": "615-441-1441",
            "fax_number": "615-441-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKSON JAW & FACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-441-1441",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS0000007915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dickson Medical Associate, PC
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• Dickson Medical Associates, PC

• 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 Jun 23, 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.