Southeast Oral Surgery PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 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

Last updated

Mar 9, 2011By 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

Michelle L Tracy

Title

Office Manater

Phone

(865) 977-7110

Specialties & licenses 1

Addresses

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.

• Rian Ahram Cho, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Lenoir City, TN
  • NPI 1336669332
  NPD (past)
• Mitchell Ryan Mascaro, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Knoxville, TN
  • NPI 1356837322
  NPD (past)

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1881992279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 MABRY HOOD RD",
            "address_2": "SUITE 105",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222221",
            "telephone_number": "865-693-4442",
            "fax_number": "865-977-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 MABRY HOOD RD",
            "address_2": "SUITE 105",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222221",
            "telephone_number": "865-693-4442",
            "fax_number": "865-977-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-09",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANATER",
        "authorized_official_telephone_number": "865-977-7110"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soul of Serenity Center
• Sound Image Inc
• South Knox Dental
• Southeast Behavioral Services
• Southeast Eye Surgery Center, LLC
• Southeast Oral Surgery PC
• Southeast Precision Clinic of Chiropractic, PLLC
• Southeast Spine & Pain Associates LLC
• Southeast Spine and Pain Associates Inc.
• Southeast Spine and Rehab Corp.

• Oral and Maxillofacial Surgery (Dentist) in Knoxville, TN
• Providers in Knoxville, 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 Mar 9, 2011; 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.