Provider Demographics
NPI:1508510496
Name:PUCKETT, KRISTEN LEIGH RICKS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LEIGH RICKS
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:LEIGH RICKS
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2202 WOODMONT DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-4038
Mailing Address - Country:US
Mailing Address - Phone:615-440-8933
Mailing Address - Fax:
Practice Address - Street 1:1005 DR DB TODD JR BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3501
Practice Address - Country:US
Practice Address - Phone:615-327-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN117571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice