| Bristol Oral/maxillofacial Surgery | |
|
350 Blountville Hwy Suite 204 Bristol TN 37620-0213 | |
| (423) 968-4114 | |
| (424) 968-4294 |
| Full Name | Bristol Oral/maxillofacial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 350 Blountville Hwy, Bristol, Tennessee |
| Authorized Official Name and Position | Donald Smith Redford (SURGEON/OWNER) |
| Authorized Official Contact | 4239684114 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bristol Oral/maxillofacial Surgery 350 Blountville Hwy Suite 204 Bristol TN 37620-0213 Ph: (423) 968-4114 | Bristol Oral/maxillofacial Surgery 350 Blountville Hwy Suite 204 Bristol TN 37620-0213 Ph: (423) 968-4114 |
| NPI Number | 1134391154 |
|---|---|
| Provider Enumeration Date | 03/31/2008 |
| Last Update Date | 08/10/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134391154 | NPI | - | NPPES |
| 0020203 | Medicaid | TN | |
| 008019894 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DS003845 (Tennessee) | Primary |
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