# GRACE DENTAL PLLC

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

## Provider details

- **NPI number:** 1316477144
- **Authorized official:** GRACE LEE DMD (OWNER)
- **Authorized official phone:** (931) 648-4100

## Contact information

- **Practice address:** 304 PROVIDENCE BLVD, CLARKSVILLE, TN 37042
- **Practice address phone:** (931) 648-4100
- **Practice address fax:** (931) 648-4988
- **Mailing address:** 304 PROVIDENCE BLVD, CLARKSVILLE, TN 37042-4326
- **Mailing address phone:** (931) 648-4100
- **Mailing address fax:** (931) 648-4988

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | TN | Yes |

## Other

- **Enumeration date:** 06/14/2017
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | Q037677 | — | TN |