# SOUTHEAST ORAL SURGERY PC

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

## Provider details

- **NPI number:** 1881992279
- **Authorized official:** MICHELLE L TRACY (OFFICE MANATER)
- **Authorized official phone:** (865) 977-7110

## Contact information

- **Practice address:** 130 MABRY HOOD RD, SUITE 105, KNOXVILLE, TN 37922-2221
- **Practice address phone:** (865) 693-4442
- **Practice address fax:** (865) 977-4132
- **Mailing address:** 130 MABRY HOOD RD, SUITE 105, KNOXVILLE, TN 37922-2221
- **Mailing address phone:** (865) 693-4442
- **Mailing address fax:** (865) 977-4132

## 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:** 03/09/2011
- **Last updated:** 03/09/2011