Provider Demographics
NPI:1316197619
Name:ANDERSON ORAL AND MAXILLOFACIAL SURGERY P.C.
Entity type:Organization
Organization Name:ANDERSON ORAL AND MAXILLOFACIAL SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:865-209-3651
Mailing Address - Street 1:175 FRANK PRICE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:TN
Mailing Address - Zip Code:37716-1420
Mailing Address - Country:US
Mailing Address - Phone:865-622-4959
Mailing Address - Fax:865-269-4336
Practice Address - Street 1:175 FRANK PRICE BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-1420
Practice Address - Country:US
Practice Address - Phone:865-622-4959
Practice Address - Fax:865-269-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000053901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty