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General NPI Number Information
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NPI Number | 1790102036
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Entity Type | Individual
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Provider Name | CLINTON LEPETICH DMD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 1441 E CALLE DE CABALLOS
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City | TEMPE
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State | AZ
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Zip | 85284-2406
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Country | US
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Telephone | 480-228-0791
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Fax |
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Provider Business Mailing Address
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Address Line | 7360 S MCCLINTOCK DR
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City | TEMPE
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State | AZ
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Zip | 85283-5001
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Country | US
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Telephone |
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D008522
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License Number State | AZ
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