Provider Demographics
NPI:1659546455
Name:MIDDLE TENNESSEE ORAL SURGERY CENTER
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE ORAL SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWEBU
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:615-327-2626
Mailing Address - Street 1:PO BOX 2162
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2162
Mailing Address - Country:US
Mailing Address - Phone:615-327-2626
Mailing Address - Fax:615-327-2607
Practice Address - Street 1:1801 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2201
Practice Address - Country:US
Practice Address - Phone:615-327-2626
Practice Address - Fax:615-327-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN80351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9176594OtherDORAL
TN0015802OtherASSURANT
TN1605591OtherUNITED CONCORDIA
TN281433OtherCIGNA
TN3731118Medicaid
TN4154703OtherBLUE CROSS BLUE SHIELD
TN3731118Medicaid