NPIMap

Organization Active NPI

Clarksville Pediatric Dentistry, PC

  • Pediatric Dentistry
  • Clarksville, TN
National Provider Identifier
1194045617
Registry record updated Jun 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
CLARKSVILLE PEDIATRIC DENTISTRY, PC
Practice address
2297 Rudolphtown Rd
Clarksville, TN 37043-2226
Phone
(931) 245-3333
Fax
(931) 245-3334
NPI assigned
Jun 7, 2010
Last updated
Jun 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2010

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

Authorized official

Name
Dr. Karyl Jean Beauchamp, DDSNPI 1528082682
Title
President
Phone
(931) 245-3333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

2297 Rudolphtown Rd
Clarksville, TN 37043-2226

Mailing address

2297 Rudolphtown Rd
Clarksville, TN 37043-2226
Phone (931) 245-3333

Other identifiers 3

IdentifierTypeStateIssuer
112051OtherTNTENNCARE LOCATION NUMBER
823192OtherTNUNITED CONCORDIA
0160078OtherTNBLUE CROSS BLUE SHIELD OF TN

National Provider Directory

National Provider Directory

Locations

2297 Rudolphtown Rd
Clarksville, TN 37043
Phone (931) 245-3333

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275955200000",
    "number": "1194045617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2297 RUDOLPHTOWN RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370432226",
            "telephone_number": "931-245-3333",
            "fax_number": "931-245-3334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2297 RUDOLPHTOWN RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370432226",
            "telephone_number": "931-245-3333",
            "fax_number": "931-245-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE PEDIATRIC DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-07",
        "last_updated": "2010-06-08",
        "status": "A",
        "authorized_official_last_name": "BEAUCHAMP",
        "authorized_official_first_name": "KARYL",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-245-3333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE LOCATION NUMBER",
            "identifier": "112051",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "823192",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TN",
            "identifier": "0160078",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2010; 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.