Provider Demographics
NPI:1720130594
Name:CLOTHIER, ELDON W (DDS)
Entity Type:Individual
Prefix:
First Name:ELDON
Middle Name:W
Last Name:CLOTHIER
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 1:1004 PROVIDENCE LANE
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005
Mailing Address - Country:US
Mailing Address - Phone:702-293-4411
Mailing Address - Fax:
Practice Address - Street 1:1150 ARIZONA ST
Practice Address - Street 2:
Practice Address - City:BOULDER CITY
Practice Address - State:NV
Practice Address - Zip Code:89005-2610
Practice Address - Country:US
Practice Address - Phone:702-293-1437
Practice Address - Fax:702-293-3733
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist