Healthcare Provider Details

I. General information

NPI: 1770075681
Provider Name (Legal Business Name): BELLANO EAST MEMPHIS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 ESTATE OFFICE DR STE 1
MEMPHIS TN
38119-3623
US

IV. Provider business mailing address

5336 ESTATE OFFICE DR STE 1
MEMPHIS TN
38119-3623
US

V. Phone/Fax

Practice location:
  • Phone: 901-681-0408
  • Fax: 901-681-9753
Mailing address:
  • Phone: 901-681-0408
  • Fax: 901-681-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS7027
License Number StateTN

VIII. Authorized Official

Name: LEANN MOORE
Title or Position: RECEPTIONIST
Credential:
Phone: 901-681-0408