Provider Demographics
NPI:1992842892
Name:WALL, CATHRYN M (DDS)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:M
Last Name:WALL
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 1:510 ACKLEN PARK DR # B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2304
Mailing Address - Country:US
Mailing Address - Phone:615-851-9999
Mailing Address - Fax:615-851-6771
Practice Address - Street 1:2020 CALDWELL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3130
Practice Address - Country:US
Practice Address - Phone:615-851-9999
Practice Address - Fax:615-851-6771
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist