# ALPHA DENTAL, PLLC

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

## Provider details

- **NPI number:** 1861560815
- **Authorized official:** MR. MATTHEW PALOMAKI DDS (OWNER)
- **Authorized official phone:** (931) 431-0200

## Contact information

- **Practice address:** 2485 FORT CAMPBELL BLVD, STE 101, CLARKSVILLE, TN 37042
- **Practice address phone:** (931) 431-0200
- **Practice address fax:** (931) 431-3022
- **Mailing address:** 2485 FORT CAMPBELL BLVD, STE 101, CLARKSVILLE, TN 37042
- **Mailing address phone:** (931) 431-0200
- **Mailing address fax:** (931) 431-3022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7505 | TN | — |
| 1223G0001X | General Practice Dentistry | 8672 | TN | Yes |

## Other

- **Enumeration date:** 11/30/2006
- **Last updated:** 03/31/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 3164063 | BCBS OF TN IDENTIFER | TN |
| 01 | — | 543902 | UNITED CONCORIDA NUMBER | TN |
| 01 | — | 7505 | DOCTORS STATE LICENSE \# | TN |