Provider Demographics
NPI:1518758408
Name:CLARKSVILLE DENTAL GROUP PLLC
Entity type:Organization
Organization Name:CLARKSVILLE DENTAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-206-0852
Mailing Address - Street 1:2858 SUMMER LAWN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4030
Mailing Address - Country:US
Mailing Address - Phone:931-206-0852
Mailing Address - Fax:
Practice Address - Street 1:1301 PEACHERS MILL RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4610
Practice Address - Country:US
Practice Address - Phone:931-572-9152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty