Healthcare Provider Details

I. General information

NPI: 1447547716
Provider Name (Legal Business Name): JEU ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 S 3RD ST STE B
MEMPHIS TN
38109-7711
US

IV. Provider business mailing address

10018 NATIONAL CLUB DR
COLLIERVILLE TN
38017-9018
US

V. Phone/Fax

Practice location:
  • Phone: 901-774-9602
  • Fax:
Mailing address:
  • Phone: 901-219-7017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS4555
License Number StateTN

VIII. Authorized Official

Name: DR. RICHARD JEU
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 901-219-7017