Active NPI
John Octave Clotworthy, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Metairie, LA
National Provider Identifier
1972756963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 2634
- Practice address
- 1014 Veterans Blvd
Metairie, LA 70005 - Phone
- (504) 833-4361
- Fax
- (504) 833-4364
- NPI assigned
- Nov 4, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 2634 | LA | Primary |
Addresses
Primary practice location
1014 Veterans Blvd
Metairie, LA 70005
Mailing address
1014 Veterans Blvd.
Metairie, LA 70005
Phone (504) 833-4361
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2634 | LA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225756800000",
"number": "1972756963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 VETERANS BLVD.",
"city": "METAIRIE",
"state": "LA",
"postal_code": "70005",
"telephone_number": "504-833-4361",
"fax_number": "504-833-4364"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1014 VETERANS BLVD",
"city": "METAIRIE",
"state": "LA",
"postal_code": "70005",
"telephone_number": "504-833-4361",
"fax_number": "504-833-4364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLOTWORTHY",
"first_name": "JOHN",
"middle_name": "OCTAVE",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-04",
"last_updated": "2008-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "LA",
"license": "2634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Metairie, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.