Provider Demographics
NPI:1912790312
Name:SCENIC CITY ORAL SURGERY, PLLC
Entity type:Organization
Organization Name:SCENIC CITY ORAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:FELTS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-541-5700
Mailing Address - Street 1:2835 NORTHPOINT BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4862
Mailing Address - Country:US
Mailing Address - Phone:423-877-3848
Mailing Address - Fax:
Practice Address - Street 1:2835 NORTHPOINT BLVD STE 105
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4862
Practice Address - Country:US
Practice Address - Phone:423-877-3848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty