Provider Demographics
NPI:1538331533
Name:G J PRYOR
Entity Type:Organization
Organization Name:G J PRYOR
Other - Org Name:CHELSEA DENTAL CLINIC , COOPER DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-458-1118
Mailing Address - Street 1:2410 CHELSEA AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38108-1515
Mailing Address - Country:US
Mailing Address - Phone:901-458-1118
Mailing Address - Fax:
Practice Address - Street 1:2410 CHELSEA AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-1515
Practice Address - Country:US
Practice Address - Phone:901-458-1118
Practice Address - Fax:901-454-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3535261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3223844Medicaid