Provider Demographics
NPI:1114299401
Name:FAMILY AND COSMETIC DENTISTRY OF MEMPHIS, PLLC
Entity Type:Organization
Organization Name:FAMILY AND COSMETIC DENTISTRY OF MEMPHIS, PLLC
Other - Org Name:FAMILY AND COSMETIC DENTISTRY OF MEMPHIS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINESH
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-323-8488
Mailing Address - Street 1:845 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4254
Mailing Address - Country:US
Mailing Address - Phone:901-323-8488
Mailing Address - Fax:
Practice Address - Street 1:845 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-4254
Practice Address - Country:US
Practice Address - Phone:901-323-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS72451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty