Provider Demographics
NPI:1326223991
Name:DR. ROBERT T. CLONINGER DDS PA
Entity Type:Organization
Organization Name:DR. ROBERT T. CLONINGER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TRUMAN
Authorized Official - Last Name:CLONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:704-735-3014
Mailing Address - Street 1:910 DONITA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-3643
Mailing Address - Country:US
Mailing Address - Phone:704-735-3014
Mailing Address - Fax:704-735-3018
Practice Address - Street 1:910 DONITA DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3643
Practice Address - Country:US
Practice Address - Phone:704-735-3014
Practice Address - Fax:704-735-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC91676OtherBCBC ID#
NC8991676Medicaid