MEDICARE: AFFORDABLE DENTURES - MEMPHIS, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1205138104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE DENTURES - MEMPHIS, P.C.

Provider Business Mailing Address
First Line	:	3481 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4654
Country	:	US
Telephone Number	:	901-320-9301
Fax Number	:

Provider Business Practice Location Address
First Line	:	3481 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-4654
Country	:	US
Telephone Number	:	901-320-9301
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GRACE E SPEER
Credential	:	DDS
Telephone Number	:	901-320-9301

Provider Enumeration Date	:	11/27/2010
Last Update Date	:	11/30/2012

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