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General NPI Number Information
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NPI Number | 1922142397
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Entity Type | Individual
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Provider Name | ROBERT CLARK CHILDRESS DDS
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Gender | Female
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 219 N OAK AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-2437
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Country | US
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Telephone | 931-528-6536
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Fax | 931-525-6706
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Provider Business Mailing Address
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Address Line | 219 N OAK AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-2437
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Country | US
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Telephone | 931-528-6536
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Fax | 931-525-6706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS3554
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License Number State | TN
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