Provider Demographics
NPI:1902954464
Name:AMERICAN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:AMERICAN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-754-0191
Mailing Address - Street 1:7535 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3812
Mailing Address - Country:US
Mailing Address - Phone:901-754-0191
Mailing Address - Fax:
Practice Address - Street 1:7535 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3812
Practice Address - Country:US
Practice Address - Phone:901-754-0191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental