Healthcare Provider Details

I. General information

NPI: 1114852506
Provider Name (Legal Business Name): CLINTON DENTAL PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N MAIN ST
CLINTON TN
37716-3027
US

IV. Provider business mailing address

501 N MAIN ST
CLINTON TN
37716-3027
US

V. Phone/Fax

Practice location:
  • Phone: 865-457-8636
  • Fax: 865-457-8967
Mailing address:
  • Phone: 865-457-8636
  • Fax: 865-457-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HUGHES
Title or Position: OFFICE MANAGER
Credential: RDH
Phone: 865-603-2824