Provider Demographics
NPI:1760508568
Name:KAKALES, ELIZABETH HARBISON (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HARBISON
Last Name:KAKALES
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 1:763 WALNUT KNOLL LN STE 1
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8858
Mailing Address - Country:US
Mailing Address - Phone:901-757-1560
Mailing Address - Fax:
Practice Address - Street 1:763 WALNUT KNOLL LN STE 1
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8858
Practice Address - Country:US
Practice Address - Phone:901-757-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0052841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice