Provider Demographics
NPI:1316551120
Name:FALCONER, KADENE KIMANI (DDS)
Entity Type:Individual
Prefix:
First Name:KADENE
Middle Name:KIMANI
Last Name:FALCONER
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 1:651 PACE ST
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-2167
Mailing Address - Country:US
Mailing Address - Phone:407-757-4201
Mailing Address - Fax:
Practice Address - Street 1:651 PACE ST
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2167
Practice Address - Country:US
Practice Address - Phone:407-757-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105191223G0001X
TN11373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice