Organization
COOPER, PROVENCE & HALEY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER A HALEY DDS (VICE PRESIDENT)
(615) 320-1392
Entity
Organization
Contact information
Practice address
207 23RD AVE N, NASHVILLE, TN 37203-1501
(615) 320-1392
(615) 329-4245
Mailing address
502 E COLLEGE ST, DICKSON, TN 37055-2016
(615) 446-9669
(615) 446-9661
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS3032
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DS4607
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS7219
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043218670
NPI LINDSEY W. COOPER,
TN
01
—
1275531972
NPI - SPENCER A HALEY
TN
01
—
1982601829
NPI TIMOTHY D. PROVENCE
TN
01
—
2006315
BCBST TIMOTHY D PROVENCE
TN
01
—
2009819
BCBST LINDSEY W. COOPER
TN
01
—
3032
LICENSE # LINDSEY W. COOP
TN
01
—
3141185
BCBST SPENCER A HALEY
TN
01
—
4607
LICENSE TIMOTHY PROVENCE
TN
01
—
7219
LICENSE SPENCER HALEY
TN
Enumeration date
04/03/2007
Last updated
05/19/2008
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