Provider Demographics
NPI:1184385783
Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Entity type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Other - Org Name:
Other - Org Type:
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 1:5270 POPLAR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3515
Mailing Address - Country:US
Mailing Address - Phone:901-255-3459
Mailing Address - Fax:901-255-3467
Practice Address - Street 1:5270 POPLAR AVE STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3515
Practice Address - Country:US
Practice Address - Phone:901-255-3459
Practice Address - Fax:901-255-3467
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty