Provider Demographics
NPI:1356652085
Name:VAN LEEUWEN, CLAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:
Last Name:VAN LEEUWEN
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 1:985180 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5180
Mailing Address - Country:US
Mailing Address - Phone:402-559-6445
Mailing Address - Fax:
Practice Address - Street 1:985180 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-5180
Practice Address - Country:US
Practice Address - Phone:402-559-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7695985-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist