MEDICARE: CAROL LEE CLEAVER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7639	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7639	OTHER	IA	STATE LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7639	OTHER	IA	DELTA DENTAL NUMBER

General Provider Information

NPI Number	:	1487721171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL LEE CLEAVER D.D.S.

Provider Business Mailing Address
First Line	:	3915 SW 29TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2044
Country	:	US
Telephone Number	:	515-256-7457
Fax Number	:

Provider Business Practice Location Address
First Line	:	4551 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2331
Country	:	US
Telephone Number	:	515-287-2493
Fax Number	:	515-287-7948

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/09/2007

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