# FIRESTONE DENTAL GROUP , P.L.L.C.

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

## Provider details

- **NPI number:** 1629129242
- **Authorized official:** LOVELACE PRESTON GIPSON II DDS (MANAGING MEMBER)
- **Authorized official phone:** (901) 525-3800

## Contact information

- **Practice address:** 1216 THOMAS ST, MEMPHIS, TN 38107-1703
- **Practice address phone:** (901) 525-3800
- **Practice address fax:** (901) 525-4040
- **Mailing address:** 1216 THOMAS ST, MEMPHIS, TN 38107-1703
- **Mailing address phone:** (901) 525-3800
- **Mailing address fax:** (901) 525-4040

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2550 | TN | Yes |

## Other

- **Enumeration date:** 01/12/2007
- **Last updated:** 10/08/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1520609 | — | TN |