Provider Demographics
NPI:1780352948
Name:WEST MEMPHIS DENTAL GROUP
Entity type:Organization
Organization Name:WEST MEMPHIS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-321-5883
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-0416
Mailing Address - Country:US
Mailing Address - Phone:662-871-9797
Mailing Address - Fax:
Practice Address - Street 1:715 CALVIN AVERY DR
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-6501
Practice Address - Country:US
Practice Address - Phone:870-735-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental