Provider Demographics
NPI:1487339198
Name:DRS. SMITH & IVERS
Entity type:Organization
Organization Name:DRS. SMITH & IVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-685-8090
Mailing Address - Street 1:766 S WHITE STATION RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4579
Mailing Address - Country:US
Mailing Address - Phone:901-685-8090
Mailing Address - Fax:901-684-1662
Practice Address - Street 1:766 S WHITE STATION RD STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4579
Practice Address - Country:US
Practice Address - Phone:901-685-8090
Practice Address - Fax:901-684-1662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty