| NPI | 1699062273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADRIENNE M JACKSON-PAYNE Dentist/Owner 901-365-9054 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 7038) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 5420) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2011-07-05 |