Provider Demographics
NPI:1962444067
Name:DUKE, CLIFFORD GRANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:GRANT
Last Name:DUKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S CONGRESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-2009
Mailing Address - Country:US
Mailing Address - Phone:615-597-7788
Mailing Address - Fax:615-597-4737
Practice Address - Street 1:612 S CONGRESS BLVD
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37166-2009
Practice Address - Country:US
Practice Address - Phone:615-597-7788
Practice Address - Fax:615-597-4737
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS3282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0097682OtherBLUE CROSS/ BLUE SHIELD