Provider Demographics
NPI:1104132869
Name:CLONTS, DAVID J (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CLONTS
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 1:263 COUNTRY CLB
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9600
Mailing Address - Country:US
Mailing Address - Phone:435-882-2850
Mailing Address - Fax:435-843-8852
Practice Address - Street 1:263 COUNTRY CLB
Practice Address - Street 2:SUITE 102
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-9600
Practice Address - Country:US
Practice Address - Phone:435-882-2850
Practice Address - Fax:435-843-8852
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT53548651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice