| NPI | 1215108923 |
|---|---|
| Doing Business As | PICKWICK FAMILY DENTAL |
| Entity Type | Organization |
| Authorized Contact | DONALD GAVIN WALLEY President 901-755-6440 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS00000004675) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000004635) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2011-03-04 |