# DUSTIN S CLEVIDENCE DMD LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dustin S Clevidence DMD LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578346748
- **Authorized official:** AMANDA MCGILL (OFFICE MANAGER)
- **Authorized official phone:** (812) 477-3393

## Contact information

- **Practice address:** 1311 KIMBER LN STE 3, EVANSVILLE, IN 47715-9149
- **Practice address phone:** (812) 477-3393
- **Practice address fax:** (812) 479-4120
- **Mailing address:** 1311 KIMBER LN STE 3, EVANSVILLE, IN 47715-9149
- **Mailing address phone:** (812) 477-3393
- **Mailing address fax:** (812) 479-4120

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 08/14/2023
- **Last updated:** 11/29/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1083225924 | — | IN |
| 05 | — | 1114364692 | — | IN |