Provider Demographics
NPI:1790446508
Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Entity Type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Other - Org Name:AMERICAN FAMILY DENTISTRY - KIRBY QUINCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:2900 KIRBY RD STE 12
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8207
Mailing Address - Country:US
Mailing Address - Phone:901-756-8976
Mailing Address - Fax:
Practice Address - Street 1:2900 KIRBY RD STE 12
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8207
Practice Address - Country:US
Practice Address - Phone:901-756-8976
Practice Address - Fax:901-756-8547
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty