Provider Demographics
NPI:1477635324
Name:ORAL & FACIAL SURGERY GROUP PC
Entity Type:Organization
Organization Name:ORAL & FACIAL SURGERY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:WERTHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-284-5650
Mailing Address - Street 1:300 20TH AVE N STE 606
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5606
Mailing Address - Country:US
Mailing Address - Phone:615-284-5650
Mailing Address - Fax:615-284-5653
Practice Address - Street 1:300 20TH AVE N STE 606
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-5606
Practice Address - Country:US
Practice Address - Phone:615-284-5650
Practice Address - Fax:615-284-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1518204Medicaid