Provider Demographics
NPI:1780850735
Name:LACANAS HERRING MACK DDS PC
Entity Type:Organization
Organization Name:LACANAS HERRING MACK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LACANAS
Authorized Official - Middle Name:HERRING
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-452-3211
Mailing Address - Street 1:183 TILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-2721
Mailing Address - Country:US
Mailing Address - Phone:901-452-3211
Mailing Address - Fax:
Practice Address - Street 1:183 TILLMAN ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-2721
Practice Address - Country:US
Practice Address - Phone:901-452-3211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty