Healthcare Provider Details

I. General information

NPI: 1386454585
Provider Name (Legal Business Name): MID-SOUTH TMJ & SLEEP APNEA DENTAL TREATMENT CTR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 RIDGE LAKE BLVD STE 106
MEMPHIS TN
38120-9475
US

IV. Provider business mailing address

795 RIDGE LAKE BLVD STE 106
MEMPHIS TN
38120-9475
US

V. Phone/Fax

Practice location:
  • Phone: 901-468-7088
  • Fax: 901-221-2280
Mailing address:
  • Phone: 901-468-7088
  • Fax: 901-221-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIZABETH GRAHAM MITCHELL
Title or Position: DENTIST, OWNER
Credential:
Phone: 901-468-7088