# CLARKSVILLE DENTAL CENTER, PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043388713
- **Authorized official:** MRS. JOAN DEWALD (PRACTICE ADMINISTRATOR)
- **Authorized official phone:** (931) 572-9175

## Contact information

- **Practice address:** 1301 PEACHERS MILL RD, CLARKSVILLE, TN 37042-4610
- **Practice address phone:** (931) 572-9152
- **Practice address fax:** (931) 572-9155
- **Mailing address:** 1301 PEACHERS MILL RD, CLARKSVILLE, TN 37042-4610
- **Mailing address phone:** (931) 572-9152
- **Mailing address fax:** (931) 572-9155

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1542 | TN | — |
| 1223G0001X | General Practice Dentistry | 3417 | TN | Yes |
| 1223G0001X | General Practice Dentistry | 6850 | TN | — |
| 1223G0001X | General Practice Dentistry | 8259 | TN | — |
| 1223G0001X | General Practice Dentistry | 8275 | TN | — |
| 1223G0001X | General Practice Dentistry | 8290 | TN | — |
| 1223G0001X | General Practice Dentistry | 8301 | TN | — |
| 1223G0001X | General Practice Dentistry | 8317 | TN | — |
| 1223G0001X | General Practice Dentistry | 8580 | TN | — |
| 1223G0001X | General Practice Dentistry | 8596 | TN | — |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 167716 | TENNCARE-DORAL | TN |
| 01 | — | 1833308 | UNITED CONCORDIA | TN |