Provider Demographics
NPI:1285808469
Name:JOHN L. CLONINGER, III, D.D.S., PLLC
Entity type:Organization
Organization Name:JOHN L. CLONINGER, III, D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLONINGER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, PLLC
Authorized Official - Phone:704-735-0765
Mailing Address - Street 1:904 DONITA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3643
Mailing Address - Country:US
Mailing Address - Phone:704-735-0765
Mailing Address - Fax:704-735-4506
Practice Address - Street 1:904 DONITA DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3643
Practice Address - Country:US
Practice Address - Phone:704-735-0765
Practice Address - Fax:704-735-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
148930391OtherDELTA DENTAL
91684OtherBCBS
873537OtherUNITED CONCORDIA
NC8991684Medicaid