| Tennessee Implant & Oral Surgery | |
|
1409 West Baddour Parkway Suite F Lebanon TN 37087 | |
| (615) 453-7800 | |
| (615) 453-7858 |
| Full Name | Tennessee Implant & Oral Surgery |
|---|---|
| Speciality | Dentist |
| Location | 1409 West Baddour Parkway, Lebanon, Tennessee |
| Authorized Official Name and Position | Russell Keith Kirk (PRESIDENT) |
| Authorized Official Contact | 6154537800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tennessee Implant & Oral Surgery 1409 West Baddour Parkway Suite F Lebanon TN 37087 Ph: (615) 453-7800 | Tennessee Implant & Oral Surgery 1409 West Baddour Parkway Suite F Lebanon TN 37087 Ph: (615) 453-7800 |
| NPI Number | 1831361013 |
|---|---|
| Provider Enumeration Date | 03/28/2008 |
| Last Update Date | 05/03/2011 |
| Medicare PECOS PAC ID | 4880879915 |
|---|---|
| Medicare Enrollment ID | O20110504000592 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831361013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 7103 (Tennessee) | Primary |
| Provider Name | Russell K Kirk |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1558322321 PECOS PAC ID: 0042495178 Enrollment ID: I20110504000618 |
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