Provider Demographics
NPI:1457478091
Name:MCDUFFEY, TARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:MCDUFFEY
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 1:9629 MILLSFORD CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8475
Mailing Address - Country:US
Mailing Address - Phone:615-364-0170
Mailing Address - Fax:
Practice Address - Street 1:927 E BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3706
Practice Address - Country:US
Practice Address - Phone:615-364-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist