| Plateau Oral And Facial Surgery | |
|
920 S Willow Ave Cookeville TN 38501-4150 | |
| (931) 525-6059 | |
| (931) 525-6099 |
| Full Name | Plateau Oral And Facial Surgery |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 920 S Willow Ave, Cookeville, Tennessee |
| Authorized Official Name and Position | Cortland Caldemeyer (OWNER) |
| Authorized Official Contact | 9315256059 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Plateau Oral And Facial Surgery 920 S Willow Ave Cookeville TN 38501-4150 Ph: (931) 525-6059 | Plateau Oral And Facial Surgery 920 S Willow Ave Cookeville TN 38501-4150 Ph: (931) 525-6059 |
| NPI Number | 1396121000 |
|---|---|
| Provider Enumeration Date | 08/04/2015 |
| Last Update Date | 08/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396121000 | NPI | - | NPPES |
| Q004187 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 9568 (Tennessee) | Primary |
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