Individual
DR. CLINT OLE BRODAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
121 PARLIAMENT DR, MARYVILLE, TN 37804-6210
(865) 977-8700
(865) 977-5464
Mailing address
121 PARLIAMENT DR, MARYVILLE, TN 37804-6210
(865) 977-8700
(865) 977-5464
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D9259
OR
1223P0221X
Pediatric Dentistry
Primary
10289
TN
390200000X
Student in an Organized Health Care Education/Training Program
D9259
OR
Other
Enumeration date
08/21/2008
Last updated
07/08/2016
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