Provider Demographics
NPI:1588735898
Name:CLOVE, BENJAMIN IVOR (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:IVOR
Last Name:CLOVE
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 1:200 CLEVELAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5652
Mailing Address - Country:US
Mailing Address - Phone:563-263-1200
Mailing Address - Fax:563-263-1223
Practice Address - Street 1:200 CLEVELAND ST STE C
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5652
Practice Address - Country:US
Practice Address - Phone:563-263-1200
Practice Address - Fax:563-263-1223
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0463430Medicaid