Organization
SOUTHEAST ORAL SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE L TRACY (OFFICE MANATER)
(865) 977-7110
Entity
Organization
Contact information
Practice address
130 MABRY HOOD RD, SUITE 105, KNOXVILLE, TN 37922-2221
(865) 693-4442
(865) 977-4132
Mailing address
130 MABRY HOOD RD, SUITE 105, KNOXVILLE, TN 37922-2221
(865) 693-4442
(865) 977-4132
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
03/09/2011
Last updated
03/09/2011
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