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NPI Code Detail

MEDICARE: MACK ENDODONTICS DDS P.C.

MEDICARE: MACK ENDODONTICS DDS P.C.
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
11223E0200XEndodontics7948TN

Other Identifiers

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

General Provider Information

NPI Number : 1558659516
Entity Type Code : Organization
Provider Name (Legal Business Name) : MACK ENDODONTICS DDS P.C.
Provider Business Mailing Address
First Line : 5180 PARK AVE STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3531
Country : US
Telephone Number : 901-683-2221
Fax Number : 901-683-2882
Provider Business Practice Location Address
First Line : 5180 PARK AVE STE 300
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3531
Country : US
Telephone Number : 901-683-2221
Fax Number : 901-683-2882
Authorized Official
Title or Position : OWNER/DENTIST
Name : EDWARD M MACK
Credential : DDS
Telephone Number : 901-683-2221
Provider Enumeration Date : 07/12/2011
Last Update Date : 07/12/2011

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