Alloplastic Reconstruction
Anaplastologist in Memphis, TN. Organization (NPI-2).
NPI number1962805812
StatusActive
Last updated in NPPESJan 9, 2015
Details
- NPI
- 1962805812
- Entity type
- Organization (NPI-2)
- Legal business name
- Alloplastic Reconstruction
- Organization subpart
- Yes
- Enumeration date
- Oct 7, 2014
- Last updated
- Jan 9, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 229N00000X | Anaplastologist | – | – | Yes |
| 156FX1700X | Technician/Technologist, Ocularist | – | – | |
| 335E00000X | Prosthetic/Orthotic Supplier | OPP00038 | AR |
Other names
- The Center For Alloplastic Facial Reconstruction (Doing Business As)
Practice location
6 W Ge Patterson AveSuite 102
Memphis, TN 38103-6413
Phone 901-410-5375 · Fax 800-977-4149
Mailing address
220 N. Van BurenLittle Rock, AR 72205
Phone 501-265-0100 · Fax 800-977-4149
Authorized official
Michael D Kaczkowski
President
5012650100
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