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General NPI Number Information
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NPI Number | 1962584151
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Entity Type | Individual
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Provider Name | JOHN EDWARD CLARY DDS
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 515 GRAND AVE STE 101
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City | AMES
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State | IA
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Zip | 50010-6061
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Country | US
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Telephone | 515-232-0558
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Fax | 515-232-2549
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Provider Business Mailing Address
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Address Line | 515 GRAND AVE STE 101
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City | AMES
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State | IA
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Zip | 50010-6061
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Country | US
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Telephone | 515-232-0558
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Fax | 515-232-2549
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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 | 06321
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License Number State | IA
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