Southeast Oral Surgery PC

Organization Active NPI Oral and Maxillofacial Surgery (Dentist) · Knoxville, TN

NPI 1881992279 · NPPES record last updated Mar 9, 2011

Key facts

NPI
1881992279
Entity type
Organization (NPI type 2)
Primary specialty
Oral and Maxillofacial Surgery (Dentist) 1223S0112X
Legal business name
SOUTHEAST ORAL SURGERY PC
Practice address
130 Mabry Hood Rd
Suite 105
Knoxville, TN 37922-2221
Phone
(865) 693-4442
Fax
(865) 977-4132
NPI assigned
Mar 9, 2011
Organization subpart
No

Authorized official

Name
Michelle L Tracy
Title
Office Manater
Phone
(865) 977-7110

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

130 Mabry Hood Rd
Ste 105
Knoxville, TN 37922
Phone (865) 693-4442

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)
Group: 193400000X SINGLE SPECIALTY GROUP
1223S0112X Yes

Addresses

Primary practice location

130 Mabry Hood Rd
Suite 105
Knoxville, TN 37922-2221

Mailing address

130 Mabry Hood Rd
Suite 105
Knoxville, TN 37922-2221
Phone (865) 693-4442

Other providers in Knoxville, TN

All providers in Knoxville, TN · Oral and Maxillofacial Surgery (Dentist) in Tennessee

Sources for this page

Verify at the official NPI Registry.