Provider Demographics
NPI:1831273861
Name:COVINGTON, JOHN STANSILL III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STANSILL
Last Name:COVINGTON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MADISON AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3410
Mailing Address - Country:US
Mailing Address - Phone:901-448-8609
Mailing Address - Fax:901-448-7545
Practice Address - Street 1:930 MADISON AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3410
Practice Address - Country:US
Practice Address - Phone:901-448-8609
Practice Address - Fax:901-448-7545
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-37261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9178233Medicaid