NPIMap

Organization Active NPI

Firestone Dental Group , P.L.L.C.

  • General Practice Dentistry
  • Memphis, TN
National Provider Identifier
1629129242
Registry record updated Oct 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2550 Issued in TN
Legal business name
FIRESTONE DENTAL GROUP , P.L.L.C.
Practice address
1216 Thomas St
Memphis, TN 38107-1703
Phone
(901) 525-3800
Fax
(901) 525-4040
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2014

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

Authorized official

Name
Lovelace Preston Gipson II, DDS
Title
Managing Member
Phone
(901) 525-3800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2550 TN Primary

Addresses

Primary practice location

1216 Thomas St
Memphis, TN 38107-1703

Mailing address

1216 Thomas St
Memphis, TN 38107-1703
Phone (901) 525-3800

Other identifiers 1

IdentifierTypeStateIssuer
1520609MedicaidTN

National Provider Directory

National Provider Directory

Locations

1216 Thomas St
Memphis, TN 38107
Phone (901) 525-3800

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1629129242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1216 THOMAS ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381071703",
            "telephone_number": "901-525-3800",
            "fax_number": "901-525-4040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1216 THOMAS ST",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381071703",
            "telephone_number": "901-525-3800",
            "fax_number": "901-525-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRESTONE DENTAL GROUP , P.L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "GIPSON",
        "authorized_official_first_name": "LOVELACE",
        "authorized_official_middle_name": "PRESTON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "901-525-3800",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "2550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520609",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2014; 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.