Organization
TENNESSEE DENTAL PROFESSIONALS PC
Active
Parent organization
TENNESSEE DENTAL PROFESSIONALS PC
Other names
Audubon Dental Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
TENNESSEE DENTAL PROFESSIONALS PC
Authorized official
KIM WILSON (CRED SUPERVISOR)
(217) 540-5170
Entity
Organization
Contact information
Practice address
370 COLONIAL ROAD, 3, MEMPHIS, TN 38117
(901) 853-9800
Mailing address
370 COLONIAL ROAD, 3, MEMPHIS, TN 38117
(901) 853-9800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
11/08/2013
Last updated
09/17/2014
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