| NPI | 1073748042 |
|---|---|
| Former Legal Business Name | CLARKSVILLE ORAL AND MAXILLOFACIAL SURGERY |
| Entity Type | Organization |
| Authorized Contact | JASON SCOTT LILLY Owner 931-552-7575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 4003) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2016-06-15 |