# IMPLANT DENTISTRY OF THE MID SOUTH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003822842
- **Authorized official:** DR. JOHN WILLIAM PAYONK D.D.S. (OWNER)
- **Authorized official phone:** (901) 767-3259

## Contact information

- **Practice address:** 1000 BROOKFIELD RD, SUITE 104, MEMPHIS, TN 38119-0802
- **Practice address phone:** (901) 767-3259
- **Practice address fax:** (901) 683-4756
- **Mailing address:** 1000 BROOKFIELD RD, SUITE 104, MEMPHIS, TN 38119-0802
- **Mailing address phone:** (901) 683-4756

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS3315 | TN | Yes |

## Other

- **Enumeration date:** 08/01/2006
- **Last updated:** 08/22/2020