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General NPI Number Information
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NPI Number | 1609304294
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Entity Type | Individual
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Provider Name | CLAYTON FRANKLIN GUNNELL DDS
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Gender | Male
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1320 N 600 E STE 2
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City | LOGAN
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State | UT
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Zip | 84341-2474
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Country | US
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Telephone | 435-752-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 517 W 1490 N APT 101
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City | LOGAN
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State | UT
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Zip | 84341-6779
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Country | US
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Telephone | 435-881-8344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10380295-9922
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License Number State | UT
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