MEDICARE: KATHERINE ELIZABETH HAM 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	122300000X	Dentist	8552	TN

General Provider Information

NPI Number	:	1588740344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELIZABETH HAM DDS

Provider Business Mailing Address
First Line	:	131 INDAIN LAKE ROAD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075
Country	:	US
Telephone Number	:	615-824-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 INDIAN LAKE RD
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-3866
Country	:	US
Telephone Number	:	615-824-1700
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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