Healthcare Provider Details

I. General information

NPI: 1932727450
Provider Name (Legal Business Name): PAIGE GASSMANN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3159 HIGHWAY 64 STE 100
EADS TN
38028-3322
US

IV. Provider business mailing address

473 HIGH POINT TER STE A
MEMPHIS TN
38122-4621
US

V. Phone/Fax

Practice location:
  • Phone: 901-465-2382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number36166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: