Provider Demographics
NPI:1831859933
Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Entity type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Other - Org Name:<UNAVAIL>
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 1:7105 BAKERS BRIDGE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2960
Mailing Address - Country:US
Mailing Address - Phone:615-376-0011
Mailing Address - Fax:615-376-0593
Practice Address - Street 1:7105 BAKERS BRIDGE AVE STE 400
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2960
Practice Address - Country:US
Practice Address - Phone:615-376-0011
Practice Address - Fax:615-376-0593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-30
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty