Provider Demographics
NPI:1982125423
Name:CLENDENNEN, PAULINA ALEXXIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:ALEXXIS
Last Name:CLENDENNEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:PAULINA
Other - Middle Name:ALEXXIS
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11102 GRAPEVINE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4763
Mailing Address - Country:US
Mailing Address - Phone:512-954-1213
Mailing Address - Fax:
Practice Address - Street 1:401 EXCHANGE BLVD
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5717
Practice Address - Country:US
Practice Address - Phone:512-806-7740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist