Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 6228 | OK |
NPI | 1043526213 |
---|---|
Provider Name | Dr. Llon Hurst Clendenen |
First Address | Tulsa, OK 74135-2901 |
Second Address | Tulsa, OK 74135-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2010 |
Last Update Date | 26/08/2010 |