Provider Demographics
NPI:1952306425
Name:CLINTON, KENAN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENAN
Middle Name:DAVID
Last Name:CLINTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6401 POPLAR AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4823
Mailing Address - Country:US
Mailing Address - Phone:901-682-8847
Mailing Address - Fax:901-682-8891
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-682-8847
Practice Address - Fax:901-682-8891
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics