Provider Demographics
NPI:1821273913
Name:DISHMON, BROOKE ERIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ERIN
Last Name:DISHMON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 PERKINS GROVE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4104
Mailing Address - Country:US
Mailing Address - Phone:901-315-5503
Mailing Address - Fax:
Practice Address - Street 1:1661 INTERNATIONAL DR
Practice Address - Street 2:STE # 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-1430
Practice Address - Country:US
Practice Address - Phone:901-315-5503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice