Provider Demographics
NPI:1790863538
Name:WALTEMATH, GARY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:WALTEMATH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 KENNER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2243
Mailing Address - Country:US
Mailing Address - Phone:615-298-2040
Mailing Address - Fax:615-383-2541
Practice Address - Street 1:104 KENNER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2243
Practice Address - Country:US
Practice Address - Phone:615-298-2040
Practice Address - Fax:615-383-2541
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN26551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice