Provider Demographics
NPI:1134843436
Name:HERMITAGE ORAL SURGERY
Entity type:Organization
Organization Name:HERMITAGE ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZBAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-883-0067
Mailing Address - Street 1:5651 FRIST BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2057
Mailing Address - Country:US
Mailing Address - Phone:615-883-0067
Mailing Address - Fax:615-883-0365
Practice Address - Street 1:5651 FRIST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2057
Practice Address - Country:US
Practice Address - Phone:615-883-0067
Practice Address - Fax:615-883-0365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty