Organization
UNIVERSITY OF TENNESSEE
Active
Organization
UNIVERSITY OF TENNESSEE
Active
Other names
Pediatric Dental Clinic at LeBonheur
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY A FERRARA (SR. VICE CHANCELLOR/ CHIEF FINANCIA)
(901) 448-5523
Entity
Organization
Contact information
Practice address
848 ADAMS AVE., SUITE 101, MEMPHIS, TN 38103-2816
(901) 448-5437
(901) 448-5438
Mailing address
875 UNION AVE., ROOM E201, MEMPHIS, TN 38103
(901) 448-6224
(901) 448-2853
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
09/04/2019
Last updated
02/13/2020
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