Provider Demographics
NPI:1649034281
Name:PHYLLIS DICKINSON-BRANCH
Entity type:Organization
Organization Name:PHYLLIS DICKINSON-BRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PYLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICKINSON-BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-466-9833
Mailing Address - Street 1:17395 US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-6162
Mailing Address - Country:US
Mailing Address - Phone:901-466-9833
Mailing Address - Fax:901-466-9834
Practice Address - Street 1:17395 US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6162
Practice Address - Country:US
Practice Address - Phone:901-466-9833
Practice Address - Fax:901-466-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty