Provider Demographics
NPI:1265653919
Name:REHORN, CLARENCE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:R
Last Name:REHORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 RODEO PARK DR E BLDG 4
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6313
Mailing Address - Country:US
Mailing Address - Phone:505-982-2578
Mailing Address - Fax:505-986-1249
Practice Address - Street 1:2905 RODEO PARK DR E BLDG 4
Practice Address - Street 2:STE 200
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6313
Practice Address - Country:US
Practice Address - Phone:505-982-2578
Practice Address - Fax:505-986-1249
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD8281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice