Provider Demographics
NPI:1487721171
Name:CLEAVER, CAROL LEE (DDS)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:CLEAVER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2044
Mailing Address - Country:US
Mailing Address - Phone:515-256-7457
Mailing Address - Fax:
Practice Address - Street 1:4551 FLEUR DR
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-2331
Practice Address - Country:US
Practice Address - Phone:515-287-2493
Practice Address - Fax:515-287-7948
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA76391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA7639OtherSTATE LICENSE NUMBER
IA1101790Medicaid
IA7639OtherDELTA DENTAL NUMBER