Organization
MACK ENDODONTICS DDS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD M MACK DDS (OWNER/DENTIST)
(901) 683-2221
Entity
Organization
Contact information
Practice address
5180 PARK AVE STE 300, MEMPHIS, TN 38119-3531
(901) 683-2221
(901) 683-2882
Mailing address
5180 PARK AVE STE 300, MEMPHIS, TN 38119-3531
(901) 683-2221
(901) 683-2882
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
7948
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5441030
—
TN
Enumeration date
07/12/2011
Last updated
07/12/2011
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