Organization
NOLA DENTAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BENNETT JR. DMD (DENTIST/OWNER)
(901) 207-4577
Entity
Organization
Contact information
Practice address
6757 E SHELBY DR, MEMPHIS, TN 38141-7846
(901) 207-4577
Mailing address
6757 E SHELBY DR, MEMPHIS, TN 38141-7846
(901) 207-4577
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10996
TENNESSEE DENTAL LICENSE NUMBER
TN
Enumeration date
10/21/2019
Last updated
10/21/2019
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