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General NPI Number Information
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NPI Number | 1497908354
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Entity Type | Organization
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Legal Business Name | ALL ABOUT KIDS PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 3285 HACKS CROSS RD STE 101
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City | MEMPHIS
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State | TN
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Zip | 38125-8918
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Country | US
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Telephone | 901-759-0970
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Fax |
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Provider Business Mailing Address
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Address Line | 3285 HACKS CROSS RD STE 101
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City | MEMPHIS
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State | TN
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Zip | 38125-8918
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Country | US
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Telephone | 901-759-0970
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Fax |
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Authorized Official
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Title or Position | CEO/PEDIATRIC DENTIST
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Name | DR. COURTNEY L WILSON
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Credential | DDS
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Telephone | 901-759-0970
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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 | 8557
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License Number State | TN
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