Provider Demographics
NPI:1679743561
Name:WOLF RIVER PLASTIC SURGERY,PC
Entity Type:Organization
Organization Name:WOLF RIVER PLASTIC SURGERY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-1050
Mailing Address - Street 1:7910 WOLF RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1725
Mailing Address - Country:US
Mailing Address - Phone:901-737-1050
Mailing Address - Fax:901-737-1107
Practice Address - Street 1:7910 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1725
Practice Address - Country:US
Practice Address - Phone:901-737-1050
Practice Address - Fax:901-737-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty