Provider Demographics
NPI:1932136454
Name:WADDELL, INEZ DAVIS (RDH)
Entity Type:Individual
Prefix:MRS
First Name:INEZ
Middle Name:DAVIS
Last Name:WADDELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 WINDSOR GREEN DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1042
Mailing Address - Country:US
Mailing Address - Phone:615-399-5240
Mailing Address - Fax:
Practice Address - Street 1:DEPT OF VETERAN AFFAIRS, DENTAL SERVICE 160
Practice Address - Street 2:1310 24TH AVE. SO.
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212
Practice Address - Country:US
Practice Address - Phone:615-327-5321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4410124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist