Provider Demographics
NPI:1467509984
Name:CLOUD, JOHN JUSTUS (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JUSTUS
Last Name:CLOUD
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 1:14922 CANTRELL ROAD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-4248
Mailing Address - Country:US
Mailing Address - Phone:501-868-3800
Mailing Address - Fax:501-868-5003
Practice Address - Street 1:14922 CANTRELL ROAD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-4248
Practice Address - Country:US
Practice Address - Phone:501-868-3800
Practice Address - Fax:501-868-5003
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR25491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice