Healthcare Provider Details

I. General information

NPI: 1821206111
Provider Name (Legal Business Name): HEATHER KECK RIDGWAY DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8119 ISABELLA LN STE 102
BRENTWOOD TN
37027-8183
US

IV. Provider business mailing address

8119 ISABELLA LN STE 102
BRENTWOOD TN
37027-8183
US

V. Phone/Fax

Practice location:
  • Phone: 615-377-7793
  • Fax: 615-377-7794
Mailing address:
  • Phone: 615-377-7793
  • Fax: 615-377-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number8575
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: