Provider Demographics
NPI:1750861431
Name:CLINGAN, CASEY DEAN (DMD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:DEAN
Last Name:CLINGAN
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 1:711 NOBILITY DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4482
Mailing Address - Country:US
Mailing Address - Phone:870-557-2783
Mailing Address - Fax:
Practice Address - Street 1:21300 HIGHWAY 62
Practice Address - Street 2:
Practice Address - City:SHADY COVE
Practice Address - State:OR
Practice Address - Zip Code:97539-7707
Practice Address - Country:US
Practice Address - Phone:541-423-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD108951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice