Mid-State Oral Surgery & Implant Center, PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

9672 Issued in TN

Legal business name

MID-STATE ORAL SURGERY & IMPLANT CENTER, PC

Practice address

445 Henslee Dr
Dickson, TN 37055-2166

Phone

(615) 441-1441

Fax

(615) 441-1460

NPI assigned

Sep 24, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Michael S. Willis, DMD

Title

Owner

Phone

(615) 441-1441

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1379980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379980800000",
    "number": "1437585346",
    "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": "MID-STATE ORAL SURGERY & IMPLANT CENTER, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-24",
        "last_updated": "2013-09-24",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-441-1441",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "9672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Holly Meeker, NP
• Enawgaw B Mehari, M.D.
• Shana Lane Meholchick, CRNA
• Jill D Mersman, ATC/L
• Mid-Cumberland Human Resource Agency (Mid-Cumberland Home Health Agency)
• Middle Tennessee Imaging LLC
• Evan Million, DPT
• Madison Rae Milton, COTA/L
• Mira Healthcare of Tennessee, PLLC
• Carol D Moore, APRN

• 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 Sep 24, 2013; 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.