Organization
GERMANTOWN SMILE DESIGN PC
Active
Other names
Pickwick Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD GAVIN WALLEY D.D.S. (PRESIDENT)
(901) 755-6440
Entity
Organization
Contact information
Practice address
7730 WOLF RIVER BLVD, SUITE 104, GERMANTOWN, TN 38138-1708
(601) 755-6440
(901) 755-6436
Mailing address
7730 WOLF RIVER BLVD, SUITE 104, GERMANTOWN, TN 38138-1708
(601) 755-6440
(901) 755-6436
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS00000004675
TN
122300000X
Dentist
DS0000004635
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4742
—
TN
05
—
9200300
—
TN
Enumeration date
03/20/2008
Last updated
03/04/2011
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