Organization
PLATEAU ORAL SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NANCY J KELLY (INSURANCE COORDINATOR)
(931) 525-6059
Entity
Organization
Contact information
Practice address
920 S WILLOW AVE, COOKEVILLE, TN 38501-4150
(931) 525-6059
(931) 525-6079
Mailing address
920 SOUTH WILLOW AVENUE, COOKEVILLE, TN 38501-4150
(931) 525-6059
(931) 525-6079
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
D57545
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3226373
—
TN
Enumeration date
05/04/2010
Last updated
06/20/2018
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