| Clarksville Pediatric Dentistry, Pc | |
|
2297 Rudolphtown Rd Clarksville TN 37043-2226 | |
| (931) 245-3333 | |
| (931) 245-3334 |
| Full Name | Clarksville Pediatric Dentistry, Pc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2297 Rudolphtown Rd, Clarksville, Tennessee |
| Authorized Official Name and Position | Karyl Jean Beauchamp (PRESIDENT) |
| Authorized Official Contact | 9312453333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clarksville Pediatric Dentistry, Pc 2297 Rudolphtown Rd Clarksville TN 37043-2226 Ph: (931) 245-3333 | Clarksville Pediatric Dentistry, Pc 2297 Rudolphtown Rd Clarksville TN 37043-2226 Ph: (931) 245-3333 |
| NPI Number | 1194045617 |
|---|---|
| Provider Enumeration Date | 06/07/2010 |
| Last Update Date | 06/08/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194045617 | NPI | - | NPPES |
| 0160078 | Other | TN | BLUE CROSS BLUE SHIELD OF TN |
| 823192 | Other | TN | UNITED CONCORDIA |
| 112051 | Other | TN | TENNCARE LOCATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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