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NPI Code Detail

MEDICARE: MEMPHIS FAMILY AND COSMETIC DENTISTRY

MEDICARE: MEMPHIS FAMILY AND COSMETIC DENTISTRY
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1245107200
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMPHIS FAMILY AND COSMETIC DENTISTRY
Provider Business Mailing Address
First Line : 845 S HIGHLAND ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-4254
Country : US
Telephone Number : 307-315-7301
Fax Number :
Provider Business Practice Location Address
First Line : 845 S HIGHLAND ST
Second Line :
City : MEMPHIS
State : TN
Zip : 38111-4254
Country : US
Telephone Number : 307-315-7301
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : BRENNAN HANSEN
Credential : DDS
Telephone Number : 307-315-7301
Provider Enumeration Date : 10/22/2025
Last Update Date : 10/22/2025

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Directions to “MEMPHIS FAMILY AND COSMETIC DENTISTRY ” Practice Location

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