NPIMap

Organization Active NPI

Clarksville Dental Center- St B

  • Dentist
  • Clarksville, TN
National Provider Identifier
1346588282
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8290 Issued in TN
Legal business name
CLARKSVILLE DENTAL CENTER- ST B
Practice address
1715 Wilma Rudolph Blvd
Suite a
Clarksville, TN 37040-6861
Phone
(931) 645-2469
Fax
(931) 551-9954
NPI assigned
Jan 28, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Authorized official

Name
Stan Montee
Title
Owner/Dentist
Phone
(931) 645-9469

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 8290 TN Primary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X 9114 TN

Addresses

Primary practice location

1715 Wilma Rudolph Blvd
Suite a
Clarksville, TN 37040-6861

Mailing address

1715 Wilma Rudolph Blvd
Suite a
Clarksville, TN 37040-6861
Phone (931) 645-2469

National Provider Directory

National Provider Directory

Locations

1715 Wilma Rudolph Blvd
Ste A
Clarksville, TN 37040
Phone (931) 645-2469

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1359331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1346588282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 WILMA RUDOLPH BLVD",
            "address_2": "SUITE A",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406861",
            "telephone_number": "931-645-2469",
            "fax_number": "931-551-9954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 WILMA RUDOLPH BLVD",
            "address_2": "SUITE A",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370406861",
            "telephone_number": "931-645-2469",
            "fax_number": "931-551-9954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE DENTAL CENTER- ST B",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-28",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "MONTEE",
        "authorized_official_first_name": "STAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "931-645-9469"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "8290",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "9114",
            "primary": false
        }
    ],
    "identifiers": [],
    "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 Jan 28, 2013; 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.