1982125423 NPI number — DR. PAULINA ALEXXIS CLENDENNEN DDS

Table of content: DR. PAULINA ALEXXIS CLENDENNEN DDS (NPI 1982125423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982125423 NPI number — DR. PAULINA ALEXXIS CLENDENNEN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLENDENNEN
Provider First Name:
PAULINA
Provider Middle Name:
ALEXXIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GONZALEZ
Provider Other First Name:
PAULINA
Provider Other Middle Name:
ALEXXIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982125423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11102 GRAPEVINE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-4763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-954-1213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 EXCHANGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78634-5717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-806-7740
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/06/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  32991 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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