Organization
WEST TENNESSEE CENTER FOR ORAL AND FACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH HARRISON TAYLOR D.D.S., M.P.H. (ORAL AND MAXILLOFACIAL SURGEON)
(731) 426-1834
Entity
Organization
Contact information
Practice address
544 ROLAND AVE, SUITE 100, JACKSON, TN 38301-4379
(731) 426-1834
(731) 426-1836
Mailing address
544 ROLAND AVE, SUITE 100, JACKSON, TN 38301-4379
(731) 426-1834
(731) 426-1836
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
D 7760
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891795605
INDIVIDUAL NPI NUMBER
TN
01
—
3731273
MEDICARE GROUP PRICING #
TN
Enumeration date
04/02/2008
Last updated
06/15/2009
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