Provider Demographics
NPI:1437148905
Name:DEASON, DARRYL T (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:T
Last Name:DEASON
Suffix:
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 1:801B W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1032
Mailing Address - Country:US
Mailing Address - Phone:615-563-2266
Mailing Address - Fax:615-563-4258
Practice Address - Street 1:801B W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1032
Practice Address - Country:US
Practice Address - Phone:615-563-2266
Practice Address - Fax:615-563-4258
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000035751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3224627Medicaid