| Grace Dental Pllc | |
|
304 Providence Blvd Clarksville TN 37042 | |
| (931) 648-4100 | |
| (931) 648-4988 |
| Full Name | Grace Dental Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 304 Providence Blvd, Clarksville, Tennessee |
| Authorized Official Name and Position | Grace Lee (OWNER) |
| Authorized Official Contact | 9316484100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grace Dental Pllc 304 Providence Blvd Clarksville TN 37042-4326 Ph: (931) 648-4100 | Grace Dental Pllc 304 Providence Blvd Clarksville TN 37042 Ph: (931) 648-4100 |
| NPI Number | 1316477144 |
|---|---|
| Provider Enumeration Date | 06/14/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316477144 | NPI | - | NPPES |
| Q037677 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Tennessee) | Primary |
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