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General NPI Number Information
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NPI Number | 1407670573
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Entity Type | Organization
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Legal Business Name | GEN SMILES
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Dates
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Enumeration Date | 11/14/2024
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Last Update Date | 11/14/2024
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Provider Practice Location Address
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Address Line | 6757 E SHELBY DR
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City | MEMPHIS
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State | TN
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Zip | 38141-7846
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Country | US
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Telephone | 901-441-6149
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Fax | 901-441-6164
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Provider Business Mailing Address
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Address Line | 6757 E SHELBY DR
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City | MEMPHIS
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State | TN
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Zip | 38141-7846
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Country | US
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Telephone | 901-441-6149
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JEFFERY DOLBERRY
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Credential | DDS
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Telephone | 901-441-6149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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