Provider Demographics
NPI:1578798666
Name:MAY, WILLIAM RUSSELL JR (DMD, MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:MAY
Suffix:JR
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5131
Mailing Address - Country:US
Mailing Address - Phone:865-983-8630
Mailing Address - Fax:865-981-4914
Practice Address - Street 1:2253 CHAMBLISS AVE NW
Practice Address - Street 2:SUITE 403
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3861
Practice Address - Country:US
Practice Address - Phone:423-709-0400
Practice Address - Fax:423-709-0401
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN101611223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10161OtherDENTAL LICENSE