Provider Demographics
NPI:1295821411
Name:AUBERTIN, MARY ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNE
Last Name:AUBERTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N ARCADIAN CIR
Mailing Address - Street 2:#202
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-5999
Mailing Address - Country:US
Mailing Address - Phone:901-578-7511
Mailing Address - Fax:
Practice Address - Street 1:910 MADISON AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-6476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7958122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist