NPIMap

Organization Active NPI

American Family Dentistry of Memphis, PC

Doing business as American Family Dentistry Olive Branch

  • General Practice Dentistry
  • Olive Branch, MS
National Provider Identifier
1447911276
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC
Doing business as
American Family Dentistry Olive Branch
Practice address
5218 Goodman Rd Ste 109
Olive Branch, MS 38654-7985
Phone
(662) 892-3633
Fax
(662) 892-3611
NPI assigned
Jan 4, 2022
Last updated
Jan 4, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
AMERICAN FAMILY DENTISTRY OF MEMPHIS, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Celia Hayes
Title
Credentialing Coordinator
Phone
(217) 540-2100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

5218 Goodman Rd Ste 109
Olive Branch, MS 38654-7985

Mailing address

5218 Goodman Rd Ste 109
Olive Branch, MS 38654-7985
Phone (662) 892-3633

Other names 1

  • American Family Dentistry Olive Branch Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Family Dentistry of Seymour23 organizations share this tax ID, including this one
Part of
Family Dentistry of Seymour

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

5218 Goodman Rd
Ste 109
Olive Branch, MS 38654
Phone (662) 667-8813

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1447911276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5218 GOODMAN RD STE 109",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547985",
            "telephone_number": "662-892-3633",
            "fax_number": "662-892-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5218 GOODMAN RD STE 109",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386547985",
            "telephone_number": "662-892-3633",
            "fax_number": "662-892-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "AMERICAN FAMILY DENTISTRY OF MEMPHIS, PC",
        "enumeration_date": "2022-01-04",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "CELIA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "217-540-2100"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Family Dentistry Olive Branch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.