Healthcare Provider Details

I. General information

NPI: 1487339198
Provider Name (Legal Business Name): DRS. SMITH & IVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 S WHITE STATION RD STE 1
MEMPHIS TN
38117-4579
US

IV. Provider business mailing address

766 S WHITE STATION RD STE 1
MEMPHIS TN
38117-4579
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-8090
  • Fax: 901-684-1662
Mailing address:
  • Phone: 901-685-8090
  • Fax: 901-684-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: JENNI OTTEN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 901-685-8090