Organization
CLARKSVILLE DENTAL CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOAN DEWALD (PRACTICE ADMINISTRATOR)
(931) 572-9175
Entity
Organization
Contact information
Practice address
1301 PEACHERS MILL RD, CLARKSVILLE, TN 37042-4610
(931) 572-9152
(931) 572-9155
Mailing address
1301 PEACHERS MILL RD, CLARKSVILLE, TN 37042-4610
(931) 572-9152
(931) 572-9155
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1542
TN
1223G0001X
General Practice Dentistry
Primary
3417
TN
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
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167716
TENNCARE-DORAL
TN
01
—
1833308
UNITED CONCORDIA
TN
Enumeration date
12/01/2006
Last updated
08/22/2020
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