| Aesthetic Dentistry Of Collierville Pllc | |
|
362 New Byhalia Rd Suite #3 Collierville TN 38017-3731 | |
| (901) 853-8116 | |
| (901) 853-0134 |
| Full Name | Aesthetic Dentistry Of Collierville Pllc |
|---|---|
| Speciality | Dentist |
| Location | 362 New Byhalia Rd, Collierville, Tennessee |
| Authorized Official Name and Position | Alan O Blanton (OWNER) |
| Authorized Official Contact | 9018538116 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aesthetic Dentistry Of Collierville Pllc 362 New Byhalia Rd Suite #3 Collierville TN 38017-3731 Ph: (901) 853-8116 | Aesthetic Dentistry Of Collierville Pllc 362 New Byhalia Rd Suite #3 Collierville TN 38017-3731 Ph: (901) 853-8116 |
| NPI Number | 1114214426 |
|---|---|
| Provider Enumeration Date | 07/07/2011 |
| Last Update Date | 10/31/2011 |
| Medicare PECOS PAC ID | 1052583846 |
|---|---|
| Medicare Enrollment ID | O20111021000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114214426 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 4231 (Tennessee) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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