Healthcare Provider Details

I. General information

NPI: 1568024131
Provider Name (Legal Business Name): MEMPHIS ENDODONTICS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 KIRBY PKWY STE 103
MEMPHIS TN
38120-4333
US

IV. Provider business mailing address

1755 KIRBY PKWY STE 103
MEMPHIS TN
38120-4333
US

V. Phone/Fax

Practice location:
  • Phone: 901-737-1927
  • Fax: 901-761-1656
Mailing address:
  • Phone: 901-737-1927
  • Fax: 901-761-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. LARRY KEVIN WELLS
Title or Position: OWNER/CLINICIAN
Credential: DMD
Phone: 901-737-1927