MEDICARE: DENTAL ERX PLLC

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

General Provider Information

NPI Number	:	1578408662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL ERX PLLC

Provider Business Mailing Address
First Line	:	9084 S WILDERWOOD LN
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-4742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9084 S WILDERWOOD LN
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-4742
Country	:	US
Telephone Number	:	901-646-0101
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANIKA MADDOX
Credential	:
Telephone Number	:	901-646-0101

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “DENTAL ERX PLLC ” Practice Location

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