# SOUTHEAST ORAL SURGERY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154596286
- **Authorized official:** MICHELLE L TRACY (OFFICE MANAGER)
- **Authorized official phone:** (865) 977-7110

## Contact information

- **Practice address:** 11548 CHAPMAN HWY, SEYMOUR, TN 37865
- **Practice address phone:** (865) 577-7800
- **Mailing address:** 11548 CHAPMAN HWY, SEYMOUR, TN 37865
- **Mailing address phone:** (865) 577-7800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 04/29/2008
- **Last updated:** 04/15/2009