Provider Demographics
NPI:1023320355
Name:DOYLE, CALLIE L M (DMD)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:L M
Last Name:DOYLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 LITTLE DEBBIE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4364
Mailing Address - Country:US
Mailing Address - Phone:423-490-7676
Mailing Address - Fax:423-490-9976
Practice Address - Street 1:5572 LITTLE DEBBIE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4364
Practice Address - Country:US
Practice Address - Phone:423-490-7676
Practice Address - Fax:423-490-9976
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY89201223G0001X
TNDS92771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice