| NPI | 1992828370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK DISHUN PAYNE Partner Owner 901-737-8714 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN DS7858) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2015-07-24 |