Provider Demographics
NPI:1992921381
Name:SMILE MAKERS OF MEMPHIS PC
Entity type:Organization
Organization Name:SMILE MAKERS OF MEMPHIS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ARLEEN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:901-755-7392
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE #9
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8221
Mailing Address - Country:US
Mailing Address - Phone:901-755-7392
Mailing Address - Fax:901-755-6442
Practice Address - Street 1:2900 KIRBY PARKWAY
Practice Address - Street 2:SUITE #9
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8221
Practice Address - Country:US
Practice Address - Phone:901-755-7392
Practice Address - Fax:901-755-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224796Medicaid