Individual provider Active NPI

Clifford Grant Duke, D.D.S.

  • Dentist
  • Smithville, TN
National Provider Identifier
1962444067
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DS3282 Issued in TN
Practice address
612 S Congress Blvd
Smithville, TN 37166-2009
Phone
(615) 597-7788
Fax
(615) 597-4737
NPI assigned
Jun 12, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DS3282 TN Primary

Addresses

Primary practice location

612 S Congress Blvd
Smithville, TN 37166-2009

Mailing address

612 S Congress Blvd
Smithville, TN 37166-2009
Phone (615) 597-7788

Other identifiers 1

IdentifierTypeStateIssuer
0097682OtherTNBLUE CROSS/ BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160822000389 TN Order and Referring Only - Other (Non-Physician) 8729373386

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1962444067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 S CONGRESS BLVD",
            "city": "SMITHVILLE",
            "state": "TN",
            "postal_code": "371662009",
            "telephone_number": "615-597-7788",
            "fax_number": "615-597-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 S CONGRESS BLVD",
            "city": "SMITHVILLE",
            "state": "TN",
            "postal_code": "371662009",
            "telephone_number": "615-597-7788",
            "fax_number": "615-597-4737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUKE",
        "first_name": "CLIFFORD",
        "middle_name": "GRANT",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "DS3282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "0097682",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Smithville, TN

Sources for this page

Verify at the official NPI Registry.