1477635324 NPI number — ORAL & FACIAL SURGERY GROUP PC

Table of content: LOGAN DUNCAN PHARMD (NPI 1477941789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477635324 NPI number — ORAL & FACIAL SURGERY GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL & FACIAL SURGERY GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477635324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 20TH AVE N STE 606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-5606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-284-5650
Provider Business Mailing Address Fax Number:
615-284-5653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 20TH AVE N STE 606
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-5606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-284-5650
Provider Business Practice Location Address Fax Number:
615-284-5653
Provider Enumeration Date:
10/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WERTHER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
615-284-5650

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1518204 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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