MEDICARE: DR. DAVID JONES CLONTZ SR. DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5384	NC

General Provider Information

NPI Number	:	1679626444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JONES CLONTZ SR. DDS

Provider Business Mailing Address
First Line	:	205 CHURCH ST NW
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-2305
Country	:	US
Telephone Number	:	828-874-2621
Fax Number	:	828-874-4556

Provider Business Practice Location Address
First Line	:	205 CHURCH ST NW
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-2305
Country	:	US
Telephone Number	:	828-874-2621
Fax Number	:	828-874-4556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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