Provider Demographics
NPI:1760531974
Name:GERMANTOWN-BARTLETT ORAL SURGERY GROUP, )P.C.
Entity Type:Organization
Organization Name:GERMANTOWN-BARTLETT ORAL SURGERY GROUP, )P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-754-8002
Mailing Address - Street 1:2136 EXETER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3922
Mailing Address - Country:US
Mailing Address - Phone:901-754-8002
Mailing Address - Fax:901-759-9113
Practice Address - Street 1:2136 EXETER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3922
Practice Address - Country:US
Practice Address - Phone:901-754-8002
Practice Address - Fax:901-759-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4274 AND 70891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU25062Medicare UPIN
TNU66623Medicare UPIN
TN3225504Medicare ID - Type UnspecifiedDR. MARODA'S PROVIDER #
TN3226060Medicare ID - Type UnspecifiedDR. HOPKINS' PROVIDER #