NPIMap

Organization Active NPI

Clarksville Dental Spa, PLLC

  • Dentist
  • Clarksville, TN
National Provider Identifier
1467739441
Registry record updated Aug 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8737 Issued in TN
Legal business name
CLARKSVILLE DENTAL SPA, PLLC
Practice address
800 Weatherly Dr
Ste. 103-B
Clarksville, TN 37043-8957
Phone
(931) 647-8437
Fax
(931) 647-8439
NPI assigned
Nov 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2013

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

Authorized official

Name
Dr. Lance H Harrison Jr., DDSNPI 1598944340
Title
Dentist/Owner
Phone
(931) 647-8437

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 8737 TN Primary

Addresses

Primary practice location

800 Weatherly Dr
Ste. 103-B
Clarksville, TN 37043-8957

Mailing address

800 Weatherly Dr
Ste. 103-B
Clarksville, TN 37043-8957
Phone (931) 647-8437

Other identifiers 1

IdentifierTypeStateIssuer
5442012MedicaidTN

National Provider Directory

National Provider Directory

Locations

800 Weatherly Dr
Ste 103B
Clarksville, TN 37043
Phone (931) 647-8437

Practitioners & affiliated clinicians

Practitioners 3

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": "1320364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377734400000",
    "number": "1467739441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 WEATHERLY DR",
            "address_2": "STE. 103-B",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438957",
            "telephone_number": "931-647-8437",
            "fax_number": "931-647-8439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WEATHERLY DR",
            "address_2": "STE. 103-B",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370438957",
            "telephone_number": "931-647-8437",
            "fax_number": "931-647-8439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE DENTAL SPA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-04",
        "last_updated": "2013-08-29",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "LANCE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "931-647-8437",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TN",
            "license": "8737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5442012",
            "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 Aug 29, 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.