Organization
PARK STATION DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MILTON SISKIN JR. D.D.S. (OWNER / DENTIST)
(901) 685-1152
Entity
Organization
Contact information
Practice address
5180 PARK AVE, SUITE 310, MEMPHIS, TN 38119-3521
(901) 685-1152
(901) 682-6846
Mailing address
5180 PARK AVE, SUITE 310, MEMPHIS, TN 38119-3521
(901) 685-1152
(901) 682-6846
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4206
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4031894
BLUE CROSS
TN
Enumeration date
02/03/2009
Last updated
02/03/2009
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