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General NPI Number Information
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NPI Number | 1598758260
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Entity Type | Individual
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Provider Name | JENNIFER L GORDON-MALONEY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 300 STONECREST BOULEVARD SUITE 385
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City | SMYRNA
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State | TN
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Zip | 37167-1200
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Country | US
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Telephone | 615-223-1200
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Fax | 615-223-1090
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Provider Business Mailing Address
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Address Line | 300 STONECREST BOULEVARD SUITE 385
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City | SMYRNA
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State | TN
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Zip | 37167-1200
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Country | US
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Telephone | 615-223-1200
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Fax | 615-223-1090
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS0000007428
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License Number State | TN
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