Provence and Haley, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS7219 Issued in TN

Legal business name

PROVENCE AND HALEY, PC

Practice address

4322 Harding Pike
Suite 201
Nashville, TN 37205-2490

Phone

(615) 829-7000

Fax

(615) 829-7001

NPI assigned

May 18, 2009

Last updated

May 18, 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

Mr. 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, and the practitioner matching its NPPES authorized official.

• Spencer A Haley, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Nashville, TN
  • NPI 1275531972
  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": "1225263460",
    "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": "4322 HARDING PIKE",
            "address_2": "SUITE 201",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052490",
            "telephone_number": "615-829-7000",
            "fax_number": "615-829-7001"
        }
    ],
    "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": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS7219",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "DS4607",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275531972",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "7219",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1982601829",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "918666",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "2006315",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "4607",
            "state": "TN"
        },
        {
            "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
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tennessee Oral & Maxillofacial Surgeons",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Stephanie Prothro, FNP
• Rebecca Protos
• April Dawn Protzman, PT
• Proud Moments ABA of Tennessee PLLC
• Proven Process LLC (BrightStar Care)
• Timothy D Provence, DDS
• Provide Locums Healthcare Providers LLC
• Providence Care Inc
• Provider Guidance LLC
• Gwen Provo-Bell, MD

• Oral and Maxillofacial Surgery (Dentist) in Nashville, TN
• Providers in Nashville, 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.