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General NPI Number Information
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NPI Number | 1497361596
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Entity Type | Organization
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Legal Business Name | CROSSTOWN DENTAL GROUP HIGHLAND ROW LLC
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 431 S HIGHLAND ST STE 115
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City | MEMPHIS
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State | TN
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Zip | 38111-1633
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Country | US
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Telephone | 901-513-5321
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Fax | 901-339-5995
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Provider Business Mailing Address
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Address Line | 431 S HIGHLAND ST STE 115
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City | MEMPHIS
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State | TN
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Zip | 38111-1633
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Country | US
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Telephone | 901-512-5321
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Fax | 901-339-5995
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DANIEL L BIRD
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Credential | DDS
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Telephone | 901-881-1234
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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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