Mary Cay Koen, DDS MS
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Goodslettsville, TN
NPI 1821113564 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1821113564
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- TN3779 (TN)
- Practice address
- 2020 Caldwell Drive
Goodslettsville, TN 37072-3579 - Phone
- (615) 851-1222
- Fax
- (615) 851-9837
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TN3779 | TN | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | TN3779 | TN | Yes |
Addresses
Primary practice location
2020 Caldwell Drive
Goodslettsville, TN 37072-3579
Mailing address
2020 Caldwell Drive
Goodslettsville, TN 37072-3579
Phone (615) 851-1222
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.