Provider Demographics
NPI:1477541464
Name:LEDBETTER, CHRISTINA WYCKOFF (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:WYCKOFF
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 OLD FORT PKWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-4265
Mailing Address - Country:US
Mailing Address - Phone:615-896-9322
Mailing Address - Fax:615-896-2122
Practice Address - Street 1:2812 OLD FORT PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4265
Practice Address - Country:US
Practice Address - Phone:615-896-9322
Practice Address - Fax:615-896-2122
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0261991223G0001X
TN91221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice