=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730343740
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY D. CLEM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2008
-----------------------------------------------------
Last Update Date | 07/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 237 S 7400 E BUILDING A
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84317-9722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-745-1222
-----------------------------------------------------
Fax | 801-745-1233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 477
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84317-0477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-745-1222
-----------------------------------------------------
Fax | 801-745-1233
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5105713
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------