Provider Demographics
NPI:1225874761
Name:HAMMONS, KATRINA HELEN (DDS)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:HELEN
Last Name:HAMMONS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:HELEN
Other - Last Name:ECCLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:127 SPADE LEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3766
Mailing Address - Country:US
Mailing Address - Phone:865-322-2219
Mailing Address - Fax:
Practice Address - Street 1:2289 RUDOLPHTOWN RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2231
Practice Address - Country:US
Practice Address - Phone:931-647-2243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice