Provider Demographics
NPI:1518283209
Name:DR. PINKSTON & DAWSON DENTAL OFFICE
Entity Type:Organization
Organization Name:DR. PINKSTON & DAWSON DENTAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-327-6166
Mailing Address - Street 1:2348 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-6638
Mailing Address - Country:US
Mailing Address - Phone:901-327-6166
Mailing Address - Fax:901-327-8453
Practice Address - Street 1:2348 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-6638
Practice Address - Country:US
Practice Address - Phone:901-327-6166
Practice Address - Fax:901-327-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000051131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5905Medicaid