Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4859 | KY |
NPI | 1033328745 |
---|---|
Provider Name | Dr. Karl Duane Clinard |
First Address | Somerset, KY 42503-6213 |
Second Address | Somerset, KY 42501-6145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AC8118108 | DEA NUMBER (01) | KY |