Organization
DICKSON JAW & FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI ANN PETTY (OFFICE MANAGER)
(615) 441-1441
Entity
Organization
Contact information
Practice address
445 HENSLEE DR, DICKSON, TN 37055-2166
(615) 441-1441
(615) 441-1460
Mailing address
445 HENSLEE DR, DICKSON, TN 37055-2166
(615) 441-1441
(615) 441-1460
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS0000007915
TN
Other
Enumeration date
09/13/2006
Last updated
06/23/2009
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