Organization
SOUTHEAST ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY P MCCONNELL DDS (CEO)
(865) 977-7110
Entity
Organization
Contact information
Practice address
1858 CREST RD, MARYVILLE, TN 37804-4305
(865) 977-7110
(865) 977-4132
Mailing address
1858 CREST RD, MARYVILLE, TN 37804-4305
(865) 977-7110
(865) 977-4132
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
08/30/2006
Last updated
04/15/2009
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