Provider Demographics
NPI:1669643318
Name:ORAL SURGERY ASSOCIATES OF WEST TENNESSEE
Entity Type:Organization
Organization Name:ORAL SURGERY ASSOCIATES OF WEST TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:SAMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-668-7412
Mailing Address - Street 1:11 MEDICAL PARK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2157
Mailing Address - Country:US
Mailing Address - Phone:731-668-7412
Mailing Address - Fax:731-668-9950
Practice Address - Street 1:11 MEDICAL PARK CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2157
Practice Address - Country:US
Practice Address - Phone:731-668-7412
Practice Address - Fax:731-668-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty