NPIMap

Organization Active NPI

Southeast Oral Surgery PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Knoxville, TN
National Provider Identifier
1952547366
Registry record updated Apr 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
SOUTHEAST ORAL SURGERY PC
Practice address
801 W Oldham Ave
Knoxville, TN 37921-2747
Phone
(865) 522-1244
Fax
(865) 525-7041
NPI assigned
Jan 7, 2009
Last updated
Apr 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2009

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

Authorized official

Name
Timothy McConnell, DDSNPI 1821071341
Title
Partner
Phone
(865) 977-7110

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

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

Addresses

Primary practice location

801 W Oldham Ave
Knoxville, TN 37921-2747

Mailing address

1858 Crest Rd
Maryville, TN 37804-4305
Phone (865) 977-7110

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239753600000",
    "number": "1952547366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1858 CREST RD",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044305",
            "telephone_number": "865-977-7110",
            "fax_number": "865-977-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W OLDHAM AVE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379212747",
            "telephone_number": "865-522-1244",
            "fax_number": "865-525-7041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST ORAL SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-07",
        "last_updated": "2009-04-15",
        "status": "A",
        "authorized_official_last_name": "MCCONNELL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "865-977-7110",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2009; 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.