MEDICARE: DR. KEVIN JAMES WORLEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS4592	TN

General Provider Information

NPI Number	:	1265580328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN JAMES WORLEY DDS

Provider Business Mailing Address
First Line	:	808 HADLEY AVE
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-3121
Country	:	US
Telephone Number	:	615-847-3821
Fax Number	:	615-847-5544

Provider Business Practice Location Address
First Line	:	808 HADLEY AVE
Second Line	:
City	:	OLD HICKORY
State	:	TN
Zip	:	37138-3121
Country	:	US
Telephone Number	:	615-847-3821
Fax Number	:	615-847-5544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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