Provider Demographics
NPI:1790384782
Name:ALONZO, KAYLEE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAYLEE
Middle Name:ANN
Last Name:ALONZO
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 1:1032 RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1799
Mailing Address - Country:US
Mailing Address - Phone:210-464-2437
Mailing Address - Fax:
Practice Address - Street 1:923 NASHVILLE PIKE STE A
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-4384
Practice Address - Country:US
Practice Address - Phone:615-241-8022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000114301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice