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General NPI Number Information
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NPI Number | 1184722324
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Entity Type | Organization
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Legal Business Name | CHURCHWELL PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1099 POPLAR VIEW LANE NORTH
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City | COLLIERVILLE
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State | TN
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Zip | 38017-9339
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Country | US
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Telephone | 901-854-9555
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Fax | 901-853-4879
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Provider Business Mailing Address
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Address Line | 1099 POPLAR VIEW LANE NORTH
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City | COLLIERVILLE
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State | TN
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Zip | 38017-9339
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Country | US
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Telephone | 901-854-9555
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Fax | 901-853-4879
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NANCY P TURNEY
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Credential |
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Telephone | 901-854-9555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3021033
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 3037302
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License Number State | TN
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