Provider Demographics
NPI:1215097233
Name:WALDON, THOMAS G (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:WALDON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:
Other - Last Name:WALDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1035 14TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37208-3050
Mailing Address - Country:US
Mailing Address - Phone:615-327-9400
Mailing Address - Fax:615-327-2806
Practice Address - Street 1:1035 14TH AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37208-3050
Practice Address - Country:US
Practice Address - Phone:615-327-9400
Practice Address - Fax:615-327-2806
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3340187Medicaid
TN5440784Medicaid