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Organization
DUSTIN S CLEVIDENCE DMD LLC
Active
Organization
DUSTIN S CLEVIDENCE DMD LLC
Active
Other names
Dustin S Clevidence DMD LLC
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA MCGILL (OFFICE MANAGER)
(812) 477-3393
Entity
Organization
Contact information
Practice address
1311 KIMBER LN STE 3, EVANSVILLE, IN 47715-9149
(812) 477-3393
(812) 479-4120
Mailing address
1311 KIMBER LN STE 3, EVANSVILLE, IN 47715-9149
(812) 477-3393
(812) 479-4120
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083225924
—
IN
05
—
1114364692
—
IN
Enumeration date
08/14/2023
Last updated
11/29/2023
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