NPIMap

Organization Active NPI

Oral and Facial Surgery Center of Dickson, PLLC

  • Ambulatory Surgical Clinic/Center
  • Dickson, TN
National Provider Identifier
1285321307
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
ORAL AND FACIAL SURGERY CENTER OF DICKSON, PLLC
Practice address
108 Sunset Rd
Dickson, TN 37055-2163
Phone
(615) 441-1441
NPI assigned
Apr 19, 2023
Last updated
Aug 28, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Authorized official

Name
William Stuart McKenzie, DMD, MDNPI 1932427317
Title
Owner
Phone
(615) 441-9514

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X NU
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

108 Sunset Rd
Dickson, TN 37055-2163

Mailing address

445 Henslee Dr
Dickson, TN 37055-2166
Phone (423) 488-6703

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230925002762 TN Part B Supplier - Ambulatory Surgical Center 1759735749 Receives reassigned benefits from 6 practitioners
Practice locations: Dickson, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285321307. Details of each certification follow.

Ambulatory surgical center certification: CCN 44C0001219

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Oral and Facial Surgery Center of Dickson, PLLC
Certification status
Active
Provider type (POS)
Ambulatory surgical center
Participating since
Apr 23, 2024
Last certification
Apr 23, 2024
Ownership / control type
Proprietary
Facility address
108 Sunset Drive, Suite B
Dickson, TN 37055

National Provider Directory

National Provider Directory
Tax ID family
Oral and Facial Surgery Center of Dickson PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

108 Sunset Rd
Dickson, TN 37055
Phone (615) 441-1441

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724803200000",
    "number": "1285321307",
    "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": "423-488-6703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 SUNSET RD",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552163",
            "telephone_number": "615-441-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORAL AND FACIAL SURGERY CENTER OF DICKSON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-19",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A",
        "authorized_official_last_name": "MCKENZIE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-441-9514",
        "authorized_official_credential": "DMD, MD"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dickson, TN

Sources for this page

Verify at the official NPI Registry.