Provider Demographics
NPI:1942292370
Name:CHEATHAM, DAVID R (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:CHEATHAM
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1754 MADISON ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2923
Mailing Address - Country:US
Mailing Address - Phone:931-647-0838
Mailing Address - Fax:931-648-3840
Practice Address - Street 1:1754 MADISON ST
Practice Address - Street 2:SUITE 4
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2923
Practice Address - Country:US
Practice Address - Phone:931-647-0838
Practice Address - Fax:931-648-3840
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNDS45161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0123261OtherBLUE CROSS BLUE SHIELD
TN3225441Medicaid