Provider Demographics
NPI:1770514911
Name:STONECREST ORAL AND MAXILLOFACIAL SURGERY, INC.
Entity type:Organization
Organization Name:STONECREST ORAL AND MAXILLOFACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL & MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:STONE CREST
Authorized Official - Middle Name:ORAL
Authorized Official - Last Name:MAXILLOFA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-223-1200
Mailing Address - Street 1:STE 385
Mailing Address - Street 2:300 STONECREST BLVD
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6819
Mailing Address - Country:US
Mailing Address - Phone:615-223-1200
Mailing Address - Fax:615-223-1090
Practice Address - Street 1:STE 385
Practice Address - Street 2:300 STONECREST BLVD
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6819
Practice Address - Country:US
Practice Address - Phone:615-223-1200
Practice Address - Fax:615-223-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728862Medicare ID - Type Unspecified