Provider Demographics
NPI:1356414189
Name:ORAL & MAXILLOFACIAL SURGICAL SPECIALISTS
Entity type:Organization
Organization Name:ORAL & MAXILLOFACIAL SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFREY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-482-1319
Mailing Address - Street 1:420 LABORATORY RD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6802
Mailing Address - Country:US
Mailing Address - Phone:865-482-1319
Mailing Address - Fax:865-481-3067
Practice Address - Street 1:420 LABORATORY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6802
Practice Address - Country:US
Practice Address - Phone:865-482-1319
Practice Address - Fax:865-481-3067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3205659Medicare ID - Type Unspecified