Clarksville Dental Center, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3417 Issued in TN

Legal business name

CLARKSVILLE DENTAL CENTER, PLLC

Practice address

1301 Peachers Mill Rd
Clarksville, TN 37042-4610

Phone

(931) 572-9152

Fax

(931) 572-9155

NPI assigned

Dec 1, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Joan Dewald

Title

Practice Administrator

Phone

(931) 572-9175

Specialties & licenses 10

Addresses

Other identifiers 2

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ernest James Dewald, DDS

  • Dentist
  • Clarksville, TN
  • NPI 1265415996
  NPD (past)
• Moana Christina Leuluai

  • Dental Hygienist
  • Clarksville, TN
  • NPI 1891665402
  NPD (past)
• Juan Omar Mancera, D.D.S.

  • Dentist
  • Clarksville, TN
  • NPI 1871976118
  NPD (past)
• Crystal Dawn Manners, D.D.S.

  • General Practice Dentistry
  • Clarksville, TN
  • NPI 1497066237
  NPD (past)
• Brooke Ashley McVey, DMD

  • Dentist
  • Clarksville, TN
  • NPI 1609396308
  NPD (past)
• Carol J Montee, DMD

  • General Practice Dentistry
  • Spring Hill, TN
  • NPI 1093864605
  NPD (past)
• Steven R Newman, DDS

  • General Practice Dentistry
  • Clarksville, TN
  • NPI 1689722134
  NPD (past)
• Mackenzie Sawyer, DDS

  • General Practice Dentistry
  • Clarksville, TN
  • NPI 1407781925
  NPD (past)
• Olivia Courtney Stovall-Wilson, DDS

  • General Practice Dentistry
  • Clarksville, TN
  • NPI 1700100302
  NPD (past)
• Britney Dawn Taylor, DDS

  • Dentist
  • Clarksville, TN
  • NPI 1225477482
  NPD (past)
• Kanika L. Booze, DMD

  • General Practice Dentistry
  • Killeen, TX
  • NPI 1780743476
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043388713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 PEACHERS MILL RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370424610",
            "telephone_number": "931-572-9152",
            "fax_number": "931-572-9155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 PEACHERS MILL RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370424610",
            "telephone_number": "931-572-9152",
            "fax_number": "931-572-9155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE DENTAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DEWALD",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "931-572-9175",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "6850",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "1542",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8301",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8580",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8275",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8596",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8290",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8317",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "8259",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "3417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1833308",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE-DORAL",
            "identifier": "167716",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarksville Cardiology P.C.
• Clarksville Cardiology PLLC
• Clarksville Chiropractic Center, PLLC
• Clarksville Collaborative Counseling LLC
• Clarksville Dental Center- St B
• Clarksville Dental Group PLLC (Clarksville Dental Center)
• Clarksville Dental Spa, PLLC
• Clarksville Dentures and Implants
• Clarksville Endoscopy Center
• Clarksville Endoscopy Center LLC

• General Practice Dentistry in Clarksville, TN
• Providers in Clarksville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.