MEDICARE: PURFIXSMILE DENTAL

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	1223G0001X	General Practice Dentistry	8726	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265603179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURFIXSMILE DENTAL

Provider Business Mailing Address
First Line	:	9245 POPLAR AVE
Second Line	:	SUITE 8-161
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-7931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9245 POPLAR AVE
Second Line	:	SUITE 8-161
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-7931
Country	:	US
Telephone Number	:	901-414-0350
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. PHILIP CARTER
Credential	:	DDS
Telephone Number	:	901-414-0350

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	09/03/2010

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1487713434 — SALAZAR DENTAL GROUP LLC
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Directions to “PURFIXSMILE DENTAL ” Practice Location

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