NPIMap

Organization Active NPI

Iroquois Family Dentistry

  • General Practice Dentistry
  • Nashville, TN
National Provider Identifier
1992717573
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2655 Issued in TN
Legal business name
IROQUOIS FAMILY DENTISTRY
Practice address
5115 Harding Pike Ste 101
Nashville, TN 37205-2721
Phone
(615) 298-2040
Fax
(615) 777-2041
NPI assigned
Aug 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maryelisa Stack
Title
Office Manager
Phone
(615) 298-2040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 2655 TN Primary

Addresses

Primary practice location

5115 Harding Pike Ste 101
Nashville, TN 37205-2721

Mailing address

5115 Harding Pike Ste 101
Nashville, TN 37205-2721
Phone (615) 298-2040

Other identifiers 4

IdentifierTypeStateIssuer
11260OtherTNDENTAL LICENSE
5014OtherTNDENTAL LICENSE
8993OtherTNDENTAL LICENSE
11000OtherTNDENTAL LICENSE

Other names 2

  • Iroquois Dentistry Doing business as
  • Gary L. Waltemath DDS PC Former legal business name

National Provider Directory

National Provider Directory

Locations

104 Kenner Ave
Ste 101
Nashville, TN 37205
Phone (615) 298-2030

5115 Harding Pike
Ste 101
Nashville, TN 37205
Phone (615) 298-2040

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1992717573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5115 HARDING PIKE STE 101",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052721",
            "telephone_number": "615-298-2040",
            "fax_number": "615-777-2041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 HARDING PIKE STE 101",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372052721",
            "telephone_number": "615-298-2040",
            "fax_number": "615-777-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "MARYELISA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "615-298-2040"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "2655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "11260",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "5014",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "8993",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "11000",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iroquois Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gary L. Waltemath DDS PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.