Healthcare Provider Details

I. General information

NPI: 1700872975
Provider Name (Legal Business Name): GLORIA J PRYOR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 CHELSEA AVE
MEMPHIS TN
38108-1515
US

IV. Provider business mailing address

2410 CHELSEA AVE
MEMPHIS TN
38108-1515
US

V. Phone/Fax

Practice location:
  • Phone: 901-458-1118
  • Fax:
Mailing address:
  • Phone: 901-458-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3535
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: