Provider Demographics
NPI:1679729016
Name:HARRY R. MACK, JR., D.D.S., M.D., LLC
Entity type:Organization
Organization Name:HARRY R. MACK, JR., D.D.S., M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-873-4495
Mailing Address - Street 1:5802 NOLENSVILLE PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6520
Mailing Address - Country:US
Mailing Address - Phone:615-873-4495
Mailing Address - Fax:615-873-4436
Practice Address - Street 1:5802 NOLENSVILLE PIKE
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6520
Practice Address - Country:US
Practice Address - Phone:615-832-5599
Practice Address - Fax:615-834-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty