Healthcare Provider Details

I. General information

NPI: 1962444067
Provider Name (Legal Business Name): CLIFFORD GRANT DUKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S CONGRESS BLVD
SMITHVILLE TN
37166-2009
US

IV. Provider business mailing address

612 S CONGRESS BLVD
SMITHVILLE TN
37166-2009
US

V. Phone/Fax

Practice location:
  • Phone: 615-597-7788
  • Fax: 615-597-4737
Mailing address:
  • Phone: 615-597-7788
  • Fax: 615-597-4737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS3282
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: