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General NPI Number Information
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NPI Number | 1396808218
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Entity Type | Organization
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Legal Business Name | JOHN A. CLINEBELL, D.D.S., M.S., P.C.
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3744 LAVISTA RD SUITE A
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City | DECATUR
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State | GA
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Zip | 30033-1006
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Country | US
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Telephone | 404-325-8116
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Fax | 404-325-0417
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Provider Business Mailing Address
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Address Line | 3744 LAVISTA RD SUITE A
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City | DECATUR
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State | GA
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Zip | 30033-1006
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Country | US
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Telephone | 404-325-8116
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Fax | 404-325-0417
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN ANDERSON CLINEBELL
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Credential | D.D.S., M.S.
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Telephone | 404-325-8116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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