Provider Demographics
NPI:1285321307
Name:ORAL AND FACIAL SURGERY CENTER OF DICKSON, PLLC
Entity type:Organization
Organization Name:ORAL AND FACIAL SURGERY CENTER OF DICKSON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:615-441-9514
Mailing Address - Street 1:445 HENSLEE DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2166
Mailing Address - Country:US
Mailing Address - Phone:423-488-6703
Mailing Address - Fax:
Practice Address - Street 1:108 SUNSET RD
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2163
Practice Address - Country:US
Practice Address - Phone:615-441-1441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty