Healthcare Provider Details

I. General information

NPI: 1659580561
Provider Name (Legal Business Name): HEATHER RIDGWAY DDS, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BRENNAN LN
FRANKLIN TN
37067-6235
US

IV. Provider business mailing address

510 BRENNAN LN
FRANKLIN TN
37067-6235
US

V. Phone/Fax

Practice location:
  • Phone: 615-887-8948
  • Fax:
Mailing address:
  • Phone: 615-887-8948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. HEATHER KECK RIDGWAY
Title or Position: PERIODONTIST
Credential: DDS, MS
Phone: 615-887-8948