Provider Demographics
NPI:1528553732
Name:KERBAUGH, ABBY MCCLELLAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:MCCLELLAN
Last Name:KERBAUGH
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 1:601 OLD HICKORY BLVD UNIT 50
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3958
Mailing Address - Country:US
Mailing Address - Phone:859-516-1788
Mailing Address - Fax:
Practice Address - Street 1:2306 MEDICAL CENTER PKWY STE B5
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3773
Practice Address - Country:US
Practice Address - Phone:615-903-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN107821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice