Provider Demographics
NPI:1407621477
Name:CLARKSVILLE DENTURES AND IMPLANTS
Entity Type:Organization
Organization Name:CLARKSVILLE DENTURES AND IMPLANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:MUTJABA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-999-2929
Mailing Address - Street 1:2808 WILMA RUDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5032
Mailing Address - Country:US
Mailing Address - Phone:931-999-2929
Mailing Address - Fax:931-233-7700
Practice Address - Street 1:2808 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5032
Practice Address - Country:US
Practice Address - Phone:931-999-2929
Practice Address - Fax:931-233-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental