Provider Demographics
NPI:1043236680
Name:VERNON, CLAIR REED (DMD)
Entity Type:Individual
Prefix:
First Name:CLAIR
Middle Name:REED
Last Name:VERNON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-2743
Mailing Address - Country:US
Mailing Address - Phone:435-882-3700
Mailing Address - Fax:435-882-4588
Practice Address - Street 1:271 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2743
Practice Address - Country:US
Practice Address - Phone:435-882-3700
Practice Address - Fax:435-882-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142519-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice