Daniel Vincent Clevenger, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

35701 Issued in CA

Practice address

675 Mariners Island Blvd #105
San Mateo, CA 94404

Phone

(650) 345-5711

Fax

(650) 345-5780

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• D Kim DMD

  • Dental Clinic/Center
  • San Mateo, CA
  • NPI 1407623739
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1215977210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 MARINERS ISLAND BLVD #105",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94404",
            "telephone_number": "650-345-5711",
            "fax_number": "650-345-5780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MARINERS ISLAND BLVD #105",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94404",
            "telephone_number": "650-345-5711",
            "fax_number": "650-345-5780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVENGER",
        "first_name": "DANIEL",
        "middle_name": "VINCENT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "35701",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• David Ross Clemens, CATC
• Marie Clemente
• Jan Clements, APRN
• Ronald Harrison Clifton Jr.
• Clinical Integrative Services, Inc
• Clinical Psychology Solutions PLLC
• Penelope Clizbe
• Siobhan Theresa Cloherty

• General Practice Dentistry in San Mateo, CA
• Providers in San Mateo, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.