Provider Demographics
NPI:1396719019
Name:MCGHEE, TAWANNA MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TAWANNA
Middle Name:MICHELLE
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAWANNA
Other - Middle Name:MICHELLE
Other - Last Name:THONDIQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:21ST STREET
Mailing Address - Street 2:BLDG 2441
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5369
Mailing Address - Country:US
Mailing Address - Phone:270-798-8614
Mailing Address - Fax:270-798-8633
Practice Address - Street 1:21ST STREET
Practice Address - Street 2:BLDG 2441
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5369
Practice Address - Country:US
Practice Address - Phone:270-798-8614
Practice Address - Fax:270-798-8633
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0121571223S0112X
TN84741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery