Individual
JENNIFER STEWART BLAKELY LOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
875 UNION AVE, DEPARTMENT OF PEDIATRIC DENTISTRY, MEMPHIS, TN 38103-3513
(901) 448-6260
(901) 448-3817
Mailing address
875 UNION AVE, DEPARTMENT OF PEDIATRIC DENTISTRY, MEMPHIS, TN 38103-3513
(901) 448-6260
(901) 448-3817
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
0401413498
VA
1223P0221X
Pediatric Dentistry
3921
AR
1223P0221X
Pediatric Dentistry
Primary
9605
TN
Other
Enumeration date
06/18/2008
Last updated
02/17/2014
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