Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 11533 | TN |
NPI | 1073264099 |
---|---|
Provider Name | Dr. Donald Kent Mauney III |
First Address | Memphis, TN 38103-8954 |
Second Address | Memphis, TN 38103-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2022 |
Last Update Date | 11/01/2022 |