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General NPI Number Information
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NPI Number | 1255760385
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Entity Type | Organization
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Legal Business Name | TENNESSEE DENTAL PROFESSIONALS PC
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 09/17/2014
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Provider Practice Location Address
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Address Line | 370 COLONIAL ROAD 3
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City | MEMPHIS
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State | TN
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Zip | 38117
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Country | US
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Telephone | 901-853-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 370 COLONIAL ROAD 3
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City | MEMPHIS
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State | TN
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Zip | 38117
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Country | US
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Telephone | 901-853-9800
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Fax |
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Authorized Official
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Title or Position | CRED SUPERVISOR
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Name | KIM WILSON
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Credential |
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Telephone | 217-540-5170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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