Provider Demographics
NPI:1033608971
Name:CLINEBELL, JOHN ANDERSON (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDERSON
Last Name:CLINEBELL
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 LAVISTA RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1006
Mailing Address - Country:US
Mailing Address - Phone:404-325-8116
Mailing Address - Fax:404-325-0417
Practice Address - Street 1:3732 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1006
Practice Address - Country:US
Practice Address - Phone:404-325-8116
Practice Address - Fax:404-325-0417
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0105371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics