Organization
FIRESTONE DENTAL GROUP , P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOVELACE PRESTON GIPSON II DDS (MANAGING MEMBER)
(901) 525-3800
Entity
Organization
Contact information
Practice address
1216 THOMAS ST, MEMPHIS, TN 38107-1703
(901) 525-3800
(901) 525-4040
Mailing address
1216 THOMAS ST, MEMPHIS, TN 38107-1703
(901) 525-3800
(901) 525-4040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2550
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1520609
—
TN
Enumeration date
01/12/2007
Last updated
10/08/2014
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