Provider Demographics
NPI:1699730598
Name:CIVILS, JANNA CLONINGER (DDS)
Entity type:Individual
Prefix:DR
First Name:JANNA
Middle Name:CLONINGER
Last Name:CIVILS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 WALTER REED DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-4647
Mailing Address - Country:US
Mailing Address - Phone:336-763-8833
Mailing Address - Fax:336-855-1343
Practice Address - Street 1:601 WALTER REED DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4647
Practice Address - Country:US
Practice Address - Phone:336-763-8833
Practice Address - Fax:336-855-1343
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9018WOtherBCBS
NC899018WMedicaid