# CENTER FOR ORAL AND FACIAL SURGERY

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

## Provider details

- **NPI number:** 1992976997
- **Authorized official:** MS. JESSICA R. FORTNER (ADMINISTRATIVE ASSISSTANT)
- **Authorized official phone:** (901) 398-0793

## Contact information

- **Practice address:** 1251 WESLEY DR, SUITE 101, MEMPHIS, TN 38116-6442
- **Practice address phone:** (901) 398-0793
- **Practice address fax:** (901) 398-0222
- **Mailing address:** 1251 WESLEY DR, SUITE 101, MEMPHIS, TN 38116-6442
- **Mailing address phone:** (901) 398-0793
- **Mailing address fax:** (901) 398-0222

## 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:** 03/18/2008
- **Last updated:** 03/18/2008