Provider Demographics
NPI:1124788229
Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Entity type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALINGCOORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:2130 W POPLAR AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-0615
Mailing Address - Country:US
Mailing Address - Phone:901-861-7007
Mailing Address - Fax:901-861-7066
Practice Address - Street 1:2130 W POPLAR AVE STE 106
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-0615
Practice Address - Country:US
Practice Address - Phone:901-861-7007
Practice Address - Fax:901-861-7066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-30
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty