Organization
RENEW DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANI GRAY DMD (OWNER)
(314) 799-7898
Entity
Organization
Contact information
Practice address
1835 MADISON ST STE A, CLARKSVILLE, TN 37043-6547
(931) 291-9373
Mailing address
1835 MADISON ST STE A, CLARKSVILLE, TN 37043-6547
(931) 291-9373
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1760436729
ASSOCIATE
—
01
—
1942640750
OWNER-DENTIST
—
Enumeration date
02/13/2020
Last updated
02/13/2020
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