Provider Demographics
NPI:1376603977
Name:SERR, CLINT L (DMD)
Entity type:Individual
Prefix:DR
First Name:CLINT
Middle Name:L
Last Name:SERR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 E LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5284
Mailing Address - Country:US
Mailing Address - Phone:865-983-4642
Mailing Address - Fax:
Practice Address - Street 1:1916 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5284
Practice Address - Country:US
Practice Address - Phone:865-983-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN120861223G0001X
AZ66061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDD-4991OtherIDAHO STATE BOARD
TN12086OtherDENTAL
AZ6606OtherSTATE LISCENCE
ORD11173OtherOREGON STATE DENTAL BOARD