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General NPI Number Information
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NPI Number | 1881257111
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Entity Type | Individual
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Provider Name | JORDAN JAY CLAWSON DDS, MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 780 BRIDGEPORT DR STE A
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3370
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Country | US
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Telephone | 208-932-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 3885 BAROSSA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7818
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Country | US
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Telephone | 208-681-9192
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8471643
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License Number State | ID
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