Basic Information
| Provider Information | |||||||||
| NPI: | 1790384782 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALONZO | ||||||||
| FirstName: | KAYLEE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1032 RUSHMORE RD | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370421799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104642437 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 923 NASHVILLE PIKE STE A | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370664384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152418022 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2020 | ||||||||
| LastUpdateDate: | 10/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 0000011430 | TN | Y | Dental Providers | Dentist | General Practice |
No ID Information.