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General NPI Number Information
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NPI Number | 1730499500
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Entity Type | Organization
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Legal Business Name | GENERATIONAL SMILES I INC.
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 6825 WINCHESTER RD STE 1A
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City | MEMPHIS
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State | TN
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Zip | 38115-4423
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Country | US
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Telephone | 901-509-2353
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Fax | 901-509-2370
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Provider Business Mailing Address
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Address Line | 6825 WINCHESTER RD STE 1A
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City | MEMPHIS
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State | TN
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Zip | 38115-4423
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Country | US
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Telephone | 901-509-2353
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Fax | 901-509-2370
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFERY DOLBERRY
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Credential | D.D.S
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Telephone | 901-794-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5273
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License Number State | TN
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