Provider Demographics
NPI:1639263783
Name:MACK, HARRY RUSSELL JR (DDS,MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:RUSSELL
Last Name:MACK
Suffix:JR
Gender:M
Credentials:DDS,MD
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Mailing Address - Street 1:5802 NOLENSVILLE PIKE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6520
Mailing Address - Country:US
Mailing Address - Phone:615-873-4495
Mailing Address - Fax:615-873-4436
Practice Address - Street 1:5802 NOLENSVILLE PIKE
Practice Address - Street 2:SUITE #103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6520
Practice Address - Country:US
Practice Address - Phone:615-873-4495
Practice Address - Fax:615-873-4436
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-05-28
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Provider Licenses
StateLicense IDTaxonomies
TN48731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery