Provider Demographics
NPI:1609304294
Name:GUNNELL, CLAYTON FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:FRANKLIN
Last Name:GUNNELL
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 1:517 W 1490 N APT 101
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6779
Mailing Address - Country:US
Mailing Address - Phone:435-881-8344
Mailing Address - Fax:
Practice Address - Street 1:1320 N 600 E STE 2
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2474
Practice Address - Country:US
Practice Address - Phone:435-752-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10380295-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice