Provider Demographics
NPI:1790826311
Name:CORDOVA FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CORDOVA FAMILY DENTISTRY
Other - Org Name:AMERICAN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:F
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:PM
Authorized Official - Phone:901-754-4383
Mailing Address - Street 1:8520 MACON RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7147
Mailing Address - Country:US
Mailing Address - Phone:901-754-4383
Mailing Address - Fax:901-754-3156
Practice Address - Street 1:8520 MACON RD
Practice Address - Street 2:SUITE #1
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-7147
Practice Address - Country:US
Practice Address - Phone:901-754-4383
Practice Address - Fax:901-754-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty