Provider Demographics
NPI:1235143991
Name:DAVIS-DUDLEY, DERANAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERANAE
Middle Name:
Last Name:DAVIS-DUDLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 CLARKSVILLE PIKE # B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37218-1909
Mailing Address - Country:US
Mailing Address - Phone:615-299-8700
Mailing Address - Fax:
Practice Address - Street 1:3915 CLARKSVILLE PIKE # B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-1909
Practice Address - Country:US
Practice Address - Phone:615-299-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000075511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice