Basic Information
| Provider Information | |||||||||
| NPI: | 1235803644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TN OMS SPECIALTY DENTAL SERVICES, PLLC | ||||||||
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| OtherOrganizationName: | KNOXVILLE ORAL & MAXILLOFACIAL SURGERY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CHURCH ST STE 1400 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372192214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5046380303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2939 ESSARY DR STE 1 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379182464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652402977 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2021 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | DASCH | ||||||||
| AuthorizedOfficialFirstName: | CHARLOTTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PROVIDER RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 5046380303 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.