Provider Demographics
NPI:1639399256
Name:CHURCHWELL, MOLLY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:M
Last Name:CHURCHWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1099 POPLAR VIEW LANE N
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9339
Mailing Address - Country:US
Mailing Address - Phone:901-854-9555
Mailing Address - Fax:901-853-4879
Practice Address - Street 1:1099 POPLAR VIEW LANE N
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9339
Practice Address - Country:US
Practice Address - Phone:901-854-9555
Practice Address - Fax:901-853-4879
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN69541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry