Provider Demographics
NPI:1689753162
Name:CLOYD, JERRY STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:STEVEN
Last Name:CLOYD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MADISON AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163
Mailing Address - Country:US
Mailing Address - Phone:901-448-6476
Mailing Address - Fax:901-448-1390
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:901-448-1390
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice