| Christ Community Dental Outreach | |
|
2953 Broad Ave Memphis TN 38112-2957 | |
| (901) 271-6061 | |
| (901) 271-6099 |
| Full Name | Christ Community Dental Outreach |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 2953 Broad Ave, Memphis, Tennessee |
| Authorized Official Name and Position | Shantelle Leatherwood (CEO) |
| Authorized Official Contact | 9012608541 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Christ Community Dental Outreach 2595 Central Ave Memphis TN 38104-5905 Ph: (901) 260-8500 | Christ Community Dental Outreach 2953 Broad Ave Memphis TN 38112-2957 Ph: (901) 271-6061 |
| NPI Number | 1942788567 |
|---|---|
| Provider Enumeration Date | 08/06/2018 |
| Last Update Date | 08/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942788567 | NPI | - | NPPES |
| 3707256 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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