Provider Demographics
NPI:1407915432
Name:WITHROW, JOHN CLAYTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLAYTON
Last Name:WITHROW
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 1:14801 SUMMIT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4789
Mailing Address - Country:US
Mailing Address - Phone:952-431-3548
Mailing Address - Fax:
Practice Address - Street 1:8650 HUDSON BLVD N
Practice Address - Street 2:SUITE105
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-9747
Practice Address - Country:US
Practice Address - Phone:651-636-1072
Practice Address - Fax:651-501-1471
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND113981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics