Healthcare Provider Details

I. General information

NPI: 1477527216
Provider Name (Legal Business Name): STEVEN LEWIS CLAWSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6364 MAIN ST
NORTH BRANCH MN
55056-6693
US

IV. Provider business mailing address

PO BOX 380
NORTH BRANCH MN
55056-0380
US

V. Phone/Fax

Practice location:
  • Phone: 651-674-8128
  • Fax:
Mailing address:
  • Phone: 651-674-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8435
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: