Provider Demographics
NPI:1720518160
Name:RAUSCH, KAITLIN POLK (DDS)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:POLK
Last Name:RAUSCH
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 STAGE RD STE 7
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3731
Mailing Address - Country:US
Mailing Address - Phone:901-382-3050
Mailing Address - Fax:
Practice Address - Street 1:6425 STAGE RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3731
Practice Address - Country:US
Practice Address - Phone:901-382-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK69201223G0001X
TN118501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice