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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