Organization
UNIVERSITY OF TENNESSEE
Active
Organization
UNIVERSITY OF TENNESSEE
Active
Parent organization
UNIVERSITY OF TENNESSEE
Other names
College of Dentistry - Operatory
Organization subpart
Yes
Provider details
NPI number
Legal business name
UNIVERSITY OF TENNESSEE
Authorized official
MR. ANTHONY A FERRARA (SR VICE CHANCELLOR CHIEF FINANCIAL)
(901) 448-5523
Entity
Organization
Contact information
Practice address
875 UNION AVE, ROOM C209, MEMPHIS, TN 38103-0001
(901) 448-6267
(901) 448-2853
Mailing address
875 UNION AVE, ROOM E201, MEMPHIS, TN 38103
(901) 448-6224
(901) 448-2853
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
—
—
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8784
STATE LICENSE
TN
Enumeration date
02/15/2006
Last updated
02/13/2020
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