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General NPI Number Information
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NPI Number | 1447911276
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Entity Type | Organization
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Legal Business Name | AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 5218 GOODMAN RD STE 109
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7985
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Country | US
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Telephone | 662-892-3633
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Fax | 662-892-3611
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Provider Business Mailing Address
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Address Line | 5218 GOODMAN RD STE 109
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-7985
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Country | US
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Telephone | 662-892-3633
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Fax | 662-892-3611
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CELIA HAYES
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Credential |
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Telephone | 217-540-2100
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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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