Healthcare Provider Details

I. General information

NPI: 1235497355
Provider Name (Legal Business Name): DENTAL PRACTICE GROUP OF TN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 E BROOKHAVEN CIR
MEMPHIS TN
38117-4501
US

IV. Provider business mailing address

136 4TH ST N STE 201
ST PETERSBURG FL
33701-3889
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-3100
  • Fax:
Mailing address:
  • Phone: 727-800-8026
  • Fax: 727-304-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: NANCY SCHIAPARELLI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 727-800-8040