WOLF RIVER DENTAL CENTER PLLC (NPI# 1851860753) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851860753 |
| Entity Type | Organization |
| Organization Name | WOLF RIVER DENTAL CENTER PLLC |
| Practice Address |
280 German Oak Dr Cordova TN 38018-7220 |
| Mailing Address |
61 Peyton Pkwy Ste 103 Collierville TN 38017-9702 |
| Practice Telephone | 9015226640 |
| Mailing Telephone | 9014914859 |
| Mailing Fax Number | 9018614031 |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2018-11-20 |
| Authorized Official Name | MAX S BREAZEAL (OWNER) |
| Authorized Official Telephone | 9014914859 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| Other Name | Type Code |
|---|---|
| Wolf River Dental Center PLLC | Doing Business As Name - Organization |
| Street Address |
280 GERMAN OAK DR |
| City | CORDOVA |
| State | TN |
| Zip Code | 38018-7220 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558580787 | Stephen Craig Alsobrook | Dentist | 280 German Oak Dr, Cordova, TN 38018-7220 | 2007-04-25 |
| 1285139915 | Danielle Volante Bauman | Dentist | 280 German Oak Dr, Cordova, TN 38018 | 2018-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588264428 | Shaquia Janai Harris | Behavior Technician | 1079 N Houston Levee Road, Cordova, TN 38018 | 2020-10-29 |
| 1366041493 | Cynthia Brantley | Behavior Technician | 1079 N Houston Levee Rd, Cordova, TN 38018 | 2020-10-20 |
| 1558901736 | At Home Physical Rehabilitation Group, LLC | Physical Therapy Assistant | 856 Willow Tree Circle, Cordova, TN 38018 | 2020-01-15 |
| 1538703038 | Scott Eric Balogh | Psychiatry & Neurology | 65 Germantown Court, Suite 203, Cordova, TN 38018 | 2019-10-29 |
| 1851871305 | Joanna H Fussell | Behavioral Analyst | 8066 Walnut Run Suite 102, Cordova, TN 38018 | 2018-08-15 |
| 1841736097 | A Guardian Care Group | Home Health | 10164 Green Moss, Cordova, TN 38018 | 2017-01-12 |
| 1497127146 | Functional Independence, Inc. | Home Health | 270 German Oak Dr., Memphis, TN 38018 | 2015-10-21 |
| 1679984363 | Tiffany Masters Redfern | Obstetrics & Gynecology | 521 Riveredge Dr W, Cordova, TN 38018 | 2014-05-15 |
| 1295073427 | Mitchell Wyman Alvarez | Optometrist | 2075 N. Germantown Pkwy, Memphis, TN 38018 | 2013-01-23 |
| 1578827531 | Chiung Feng Hsu | Dentist | 831 Timber Creek Dr #1, Cordova, TN 38018 | 2012-06-25 |
| Find all providers in zip 38018 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578106852 | David H Kim | Dentist | 2058 Kings Cross Ln, Cordova, TN 38016-5176 | 2019-10-19 |
| 1093375321 | James D Ritter | Dentist | 8135 Walnut Grove Rd Ste 4, Cordova, TN 38018-4262 | 2019-06-18 |
| 1841725843 | Dentalcares | Dentist | 1890 N Germantown Pkwy Ste 105, Cordova, TN 38016-3325 | 2017-04-27 |
| 1922428986 | Mitra Kohan | Dentist | 9200 Chimneyrock Blvd Ste 104, Cordova, TN 38016-2201 | 2014-04-17 |
| 1508117466 | Candyce Jaye Thompson | Dentist | 1890 N Germantown Pkwy, Cordova, TN 38016-3324 | 2012-10-01 |
| 1578827531 | Chiung Feng Hsu | Dentist | 831 Timber Creek Dr #1, Cordova, TN 38018 | 2012-06-25 |
| 1336260801 | Nicky Andrew Fong | Dentist | 831 Timber Creek Dr, Suite 1, Cordova, TN 38018-3108 | 2007-04-03 |
| 1639204837 | Stuart M. Taylor Sr. | Dentist | 86 Timber Creek Dr, Suite 3, Cordova, TN 38018-4284 | 2007-02-21 |
| 1477690915 | Gilbert Lyle Urata | Dentist | 301 Browning Ave, Cordova, AK 99574-0518 | 2007-02-01 |
| 1487702015 | William Michael Smith | Dentist | 1890 N Germantown Parkway, Ste 105, Cordova, TN 38018 | 2007-01-08 |
| Find all providers in CORDOVA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.