| Firestone Dental Group , P.l.l.c. | |
|
1216 Thomas St Memphis TN 38107-1703 | |
| (901) 525-3800 | |
| (901) 525-4040 |
| Full Name | Firestone Dental Group , P.l.l.c. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1216 Thomas St, Memphis, Tennessee |
| Authorized Official Name and Position | Lovelace Preston Gipson (MANAGING MEMBER) |
| Authorized Official Contact | 9015253800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Firestone Dental Group , P.l.l.c. 1216 Thomas St Memphis TN 38107-1703 Ph: (901) 525-3800 | Firestone Dental Group , P.l.l.c. 1216 Thomas St Memphis TN 38107-1703 Ph: (901) 525-3800 |
| NPI Number | 1629129242 |
|---|---|
| Provider Enumeration Date | 01/12/2007 |
| Last Update Date | 10/08/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629129242 | NPI | - | NPPES |
| 1520609 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 2550 (Tennessee) | Primary |
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