Brent Wills Church, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

11892 Issued in TN

Practice address

1684 Poplar Ave
Memphis, TN 38104-2583

Phone

(901) 254-1990

NPI assigned

Aug 9, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Leblanc & Associates Dentistry for Children, P.a.

  • Pediatric Dentistry
  • Olathe, KS
  • NPI 1790021459
  NPD (past)
• Rem Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Shawnee, KS
  • NPI 1417609405
  NPD (past)

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

{
    "created_epoch": "1344470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1669729588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4270 CHICKASAW RD",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381171615",
            "telephone_number": "901-652-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1684 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042583",
            "telephone_number": "901-254-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "BRENT",
        "middle_name": "WILLS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-09",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3659-12",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KS",
            "license": "61218",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "KS",
            "license": "61218",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "11892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Smriti Chuke, MD
• Valentine Uche Chukwuma, MD, PHD
• Mason Mark Chumpia, M.D.
• Elaine S Chung, DO
• Church Health Center of Memphis Inc
• Daniel W Church
• Reagan Churchill
• Lakesha Churn, OT
• Roger S Cicala, MD
• Circle of Faith Christian Center

• All providers in Memphis, TN
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; 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.