Clarksville Tongue Tie Center PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

CLARKSVILLE TONGUE TIE CENTER PLLC

Practice address

590 Fire Station Rd Ste D
Clarksville, TN 37043-4076

Phone

(931) 444-3410

NPI assigned

Jul 5, 2021

Organization subpart

No

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

Authorized official

Name

Kevin Kennedy Jr., DDSNPI 1629399647

Title

Owner

Phone

(931) 206-0852

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Locations

Practitioners 1

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

• Kevin Chambliss Kennedy Jr., DDS

  • Pediatric Dentistry
  • Clarksville, TN
  • NPI 1629399647
  NPD Authorized official

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

{
    "created_epoch": "1625443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625443200000",
    "number": "1811568561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 FIRE STATION RD STE D",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434076",
            "telephone_number": "931-444-3410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FIRE STATION RD STE D",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370434076",
            "telephone_number": "931-444-3410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE TONGUE TIE CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-05",
        "last_updated": "2021-07-05",
        "certification_date": "2021-07-05",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-206-0852",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Mail",
            "affiliation": "N",
            "address_1": "590 Fire Station Rd Ste D",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370434076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatric Dentistry in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Pediatric Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2021; 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.