Provider Demographics
NPI:1396808218
Name:JOHN A. CLINEBELL, D.D.S., M.S., P.C.
Entity type:Organization
Organization Name:JOHN A. CLINEBELL, D.D.S., M.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:CLINEBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:404-325-8116
Mailing Address - Street 1:3744 LAVISTA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1006
Mailing Address - Country:US
Mailing Address - Phone:404-325-8116
Mailing Address - Fax:404-325-0417
Practice Address - Street 1:3744 LAVISTA RD
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1006
Practice Address - Country:US
Practice Address - Phone:404-325-8116
Practice Address - Fax:404-325-0417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty