Healthcare Provider Details

I. General information

NPI: 1598758260
Provider Name (Legal Business Name): JENNIFER L GORDON-MALONEY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONECREST BOULEVARD SUITE 385
SMYRNA TN
37167-1200
US

IV. Provider business mailing address

300 STONECREST BOULEVARD SUITE 385
SMYRNA TN
37167-1200
US

V. Phone/Fax

Practice location:
  • Phone: 615-223-1200
  • Fax: 615-223-1090
Mailing address:
  • Phone: 615-223-1200
  • Fax: 615-223-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS0000007428
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: