Provider Demographics
NPI:1932860756
Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Entity Type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Other - Org Name:AMERICAN FAMILY DENTISTRY KINGSTON PIKE
Other - Org Type:Doing Business As
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 1:9269 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-2318
Mailing Address - Country:US
Mailing Address - Phone:865-622-5494
Mailing Address - Fax:
Practice Address - Street 1:9269 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-2318
Practice Address - Country:US
Practice Address - Phone:865-622-5494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty