Provider Demographics
NPI:1053449637
Name:AVERY AND MEADOWS, DDS, PC
Entity Type:Organization
Organization Name:AVERY AND MEADOWS, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-452-0040
Mailing Address - Street 1:3491 WALNUT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4620
Mailing Address - Country:US
Mailing Address - Phone:901-452-0040
Mailing Address - Fax:901-452-0256
Practice Address - Street 1:3491 WALNUT GROVE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4620
Practice Address - Country:US
Practice Address - Phone:901-452-0040
Practice Address - Fax:901-452-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS33931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty