# ORAL SURGICAL INSTITUTE, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ORAL SURGICAL INSTITUTE, P.C.
- **Other names:** Oral Surgery Institute - Springfield
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1760885578
- **Legal business name:** ORAL SURGICAL INSTITUTE, P.C.
- **Authorized official:** KIM WILSON (CRED SUPERVISOR)
- **Authorized official phone:** (217) 540-5170

## Contact information

- **Practice address:** 314 NORTHCREST DR STE 134, SPRINGFIELD, TN 37172-3963
- **Practice address phone:** (615) 384-1104
- **Mailing address:** 314 NORTHCREST DRIVE, SUITE 134, SPRINGFIELD, TN 37172
- **Mailing address phone:** (615) 384-1104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 10/07/2014
- **Last updated:** 10/07/2014