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Organization
IROQUOIS FAMILY DENTISTRY
Active
Organization
IROQUOIS FAMILY DENTISTRY
Active
Other names
Iroquois Dentistry, Gary L. Waltemath DDS PC
Organization subpart
No
Provider details
NPI number
Authorized official
MARYELISA STACK (OFFICE MANAGER)
(615) 298-2040
Entity
Organization
Contact information
Practice address
5115 HARDING PIKE STE 101, NASHVILLE, TN 37205-2721
(615) 298-2040
(615) 777-2041
Mailing address
5115 HARDING PIKE STE 101, NASHVILLE, TN 37205-2721
(615) 298-2040
(615) 777-2041
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2655
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11000
DENTAL LICENSE
TN
01
—
11260
DENTAL LICENSE
TN
01
—
5014
DENTAL LICENSE
TN
01
—
8993
DENTAL LICENSE
TN
Enumeration date
08/12/2006
Last updated
01/19/2021
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