Provider Demographics
NPI:1881257111
Name:CLAWSON, JORDAN JAY (DDS, MD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JAY
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 BAROSSA DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7818
Mailing Address - Country:US
Mailing Address - Phone:208-681-9192
Mailing Address - Fax:
Practice Address - Street 1:780 BRIDGEPORT DR STE A
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3370
Practice Address - Country:US
Practice Address - Phone:208-932-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID84716431223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery