Provider Demographics
NPI:1518371251
Name:CLAWSON, PAUL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:CLAWSON
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 1:1601 12TH AVE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7711
Mailing Address - Country:US
Mailing Address - Phone:208-467-9690
Mailing Address - Fax:208-466-0412
Practice Address - Street 1:1601 12TH AVE RD
Practice Address - Street 2:STE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-7711
Practice Address - Country:US
Practice Address - Phone:208-467-9690
Practice Address - Fax:208-466-0412
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-45751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice