MEDICARE: DR. JEFFREY POPE FRIZZELL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS3929	TN

General Provider Information

NPI Number	:	1194706697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY POPE FRIZZELL DDS

Provider Business Mailing Address
First Line	:	785 ESTATE PL 2
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-0639
Country	:	US
Telephone Number	:	901-766-9002
Fax Number	:	901-766-9031

Provider Business Practice Location Address
First Line	:	4177 MACON RD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38122-2413
Country	:	US
Telephone Number	:	901-454-6103
Fax Number	:	901-454-6103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	11/18/2015

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