James Edward Clark III, D.D.S.

Individual provider Active NPI General Practice Dentistry · Nolensville, TN

NPI 1104836840 · NPPES record last updated Apr 24, 2014

Key facts

NPI
1104836840
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
7500 (TN)
Practice address
921 Oldham Dr
Nolensville, TN 37135-9455
Phone
(615) 776-3592
NPI assigned
Aug 8, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
7500TNMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 7500 TN Yes

Addresses

Primary practice location

921 Oldham Dr
Nolensville, TN 37135-9455

Mailing address

921 Oldham Dr
Nolensville, TN 37135-9455
Phone (615) 776-3592

Other providers in Nolensville, TN

All providers in Nolensville, TN · General Practice Dentistry in Tennessee

Sources for this page

Verify at the official NPI Registry.