Provider Demographics
NPI:1043526213
Name:CLENDENEN, LLON HURST (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LLON
Middle Name:HURST
Last Name:CLENDENEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3305 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-2901
Mailing Address - Country:US
Mailing Address - Phone:918-743-2315
Mailing Address - Fax:918-743-2243
Practice Address - Street 1:3305 E 45TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2901
Practice Address - Country:US
Practice Address - Phone:918-743-2315
Practice Address - Fax:918-743-2243
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK62281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics