Basic Information
| Provider Information | |||||||||
| NPI: | 1124478003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZACHARIAS | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 100 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153294401 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 20TH AVE N STE 100 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153294401 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 07/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204E00000X | DL12925 | MA | N | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 204E00000X | 65221 | TN | N | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 204E00000X | 11680 | TN | Y | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery |
ID Information
| ID | Type | State | Issuer | Description | Q073817 | 05 | TN | MEDICAID |