Harry Russell Mack Jr., DDS,MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

4873 Issued in TN

Practice address

5802 Nolensville Pike
Suite #103
Nashville, TN 37211-6520

Phone

(615) 873-4495

Fax

(615) 873-4436

NPI assigned

Oct 3, 2006

Last updated

May 28, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 18, 2015 through Dec 18, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Harry R. Mack, Jr., D.D.S., M.D., LLC

  dba Nashville Oral Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Nashville, TN
  • NPI 1679729016
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401235200000",
    "number": "1639263783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5802 NOLENSVILLE PIKE",
            "address_2": "SUITE #103",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372116520",
            "telephone_number": "615-873-4495",
            "fax_number": "615-873-4436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5802 NOLENSVILLE PIKE",
            "address_2": "SUITE #103",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372116520",
            "telephone_number": "615-873-4495",
            "fax_number": "615-873-4436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACK",
        "first_name": "HARRY",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS,MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2014-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "4873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Galileo Macinnis, AG-ACNP-BC
• Christina Aleksandra Maciuszko, RN, NBC-HWC
• Brenda Mack, ST
• Brian Richard Mack, M.D.
• Caroline Caton Mack, PA-C
• Shannon Michelle Mack, RN
• Darby Mackenstadt
• Mackenzie Alcorn LLC
• Adrien Grey Mackenzie, PTA, LMT, CLT-LANA
• Amanda Mackenzie

• 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 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.