MEDICARE: DRS. SMITH & IVERS

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)

General Provider Information

NPI Number	:	1487339198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS. SMITH & IVERS

Provider Business Mailing Address
First Line	:	766 S WHITE STATION RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-4579
Country	:	US
Telephone Number	:	901-685-8090
Fax Number	:	901-684-1662

Provider Business Practice Location Address
First Line	:	766 S WHITE STATION RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-4579
Country	:	US
Telephone Number	:	901-685-8090
Fax Number	:	901-684-1662

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	JENNI OTTEN
Credential	:
Telephone Number	:	901-685-8090

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “DRS. SMITH & IVERS ” Practice Location

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