Individual
DAVID GRANT CLEVERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6217-005
WI
1223G0001X
General Practice Dentistry
6638
NE
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6217
WI
Other
Enumeration date
11/06/2007
Last updated
04/24/2014
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