Healthcare Provider Details

I. General information

NPI: 1942292370
Provider Name (Legal Business Name): DAVID R CHEATHAM D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 MADISON ST SUITE 4
CLARKSVILLE TN
37043-2923
US

IV. Provider business mailing address

1754 MADISON ST SUITE 4
CLARKSVILLE TN
37043-2923
US

V. Phone/Fax

Practice location:
  • Phone: 931-647-0838
  • Fax: 931-648-3840
Mailing address:
  • Phone: 931-647-0838
  • Fax: 931-648-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS4516
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: