Provider Demographics
NPI:1124398805
Name:BELLOTT & PARRISH DENTISTRY
Entity Type:Organization
Organization Name:BELLOTT & PARRISH DENTISTRY
Other - Org Name:AUDUBON DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/BUSINESS OWENER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-853-9800
Mailing Address - Street 1:2059 S HOUSTON LEVEE RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-6970
Mailing Address - Country:US
Mailing Address - Phone:901-853-9800
Mailing Address - Fax:
Practice Address - Street 1:2059 S HOUSTON LEVEE RD
Practice Address - Street 2:SUITE 126
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-6970
Practice Address - Country:US
Practice Address - Phone:901-853-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS30211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty