Provider Demographics
NPI:1720250954
Name:BRIAN K SCHENCK ORAL SURGERY, PC
Entity Type:Organization
Organization Name:BRIAN K SCHENCK ORAL SURGERY, PC
Other - Org Name:CHATTANOOGA OMS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-875-4812
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5446
Mailing Address - Country:US
Mailing Address - Phone:423-875-4812
Mailing Address - Fax:423-875-4814
Practice Address - Street 1:4845 HIXSON PIKE STE A
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4466
Practice Address - Country:US
Practice Address - Phone:423-875-4812
Practice Address - Fax:423-875-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS18831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3215227Medicaid