# PARK STATION DENTAL GROUP

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

## Provider details

- **NPI number:** 1407094121
- **Authorized official:** DR. MILTON SISKIN JR. D.D.S. (OWNER / DENTIST)
- **Authorized official phone:** (901) 685-1152

## Contact information

- **Practice address:** 5180 PARK AVE, SUITE 310, MEMPHIS, TN 38119-3521
- **Practice address phone:** (901) 685-1152
- **Practice address fax:** (901) 682-6846
- **Mailing address:** 5180 PARK AVE, SUITE 310, MEMPHIS, TN 38119-3521
- **Mailing address phone:** (901) 685-1152
- **Mailing address fax:** (901) 682-6846

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4206 | TN | Yes |

## Other

- **Enumeration date:** 02/03/2009
- **Last updated:** 02/03/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4031894 | BLUE CROSS | TN |