# IROQUOIS FAMILY DENTISTRY

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Iroquois Dentistry, Gary L. Waltemath DDS PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992717573
- **Authorized official:** MARYELISA STACK (OFFICE MANAGER)
- **Authorized official phone:** (615) 298-2040

## Contact information

- **Practice address:** 5115 HARDING PIKE STE 101, NASHVILLE, TN 37205-2721
- **Practice address phone:** (615) 298-2040
- **Practice address fax:** (615) 777-2041
- **Mailing address:** 5115 HARDING PIKE STE 101, NASHVILLE, TN 37205-2721
- **Mailing address phone:** (615) 298-2040
- **Mailing address fax:** (615) 777-2041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2655 | TN | Yes |

## Other

- **Enumeration date:** 08/12/2006
- **Last updated:** 01/19/2021

## 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 |