Provider Demographics
NPI:1689744393
Name:KINDER, TATUM L (DDS)
Entity Type:Individual
Prefix:
First Name:TATUM
Middle Name:L
Last Name:KINDER
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 1:1420 E STONE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4165
Mailing Address - Country:US
Mailing Address - Phone:423-247-6961
Mailing Address - Fax:423-247-5552
Practice Address - Street 1:1420 E STONE DR
Practice Address - Street 2:SUITE G
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4165
Practice Address - Country:US
Practice Address - Phone:423-247-6961
Practice Address - Fax:423-247-5552
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS81051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4065562OtherBCBS TN