Individual
DR. SANFORD JAY FENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
875 UNION AVE, S 217 B, MEMPHIS, TN 38163-0001
(901) 448-6206
(901) 448-6249
Mailing address
8658 STABLEMILL LN, CORDOVA, TN 38016-6154
(870) 733-3854
(870) 733-3851
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
3314
AR
1223P0221X
Pediatric Dentistry
Primary
DS0000007119
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0005926
TENNCARE PROVIDER NUMBER
TN
Enumeration date
11/13/2006
Last updated
07/09/2007
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