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4322 Harding Pike Suite 201 Nashville TN 37205-2490 | |
| (615) 829-7000 | |
| (615) 829-7001 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 4322 Harding Pike, Nashville, Tennessee |
| Authorized Official Name and Position | Mina H Harris (OFFICE MANAGER) |
| Authorized Official Contact | 6154191943 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4322 Harding Pike Suite 201 Nashville TN 37205-2490 Ph: (615) 829-7000 | 4322 Harding Pike Suite 201 Nashville TN 37205-2490 Ph: (615) 829-7000 |
| NPI Number | 1225263460 |
|---|---|
| Provider Enumeration Date | 05/18/2009 |
| Last Update Date | 05/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225263460 | NPI | - | NPPES |
| 1275531972 | Other | NPI | |
| 7219 | Other | TN | DENTAL LICENSE |
| 1982601829 | Other | NPI | |
| 918666 | Other | UNITED CONCORDIA | |
| 2006315 | Other | TN | BCBST |
| 4607 | Other | TN | DENTAL LICENSE |
| 3141185 | Other | TN | BCBST |
| 667954 | Other | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DS7219 (Tennessee) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DS4607 (Tennessee) | Secondary |
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