Provider Demographics
NPI:1114106655
Name:SPENCER, CLAYTON GLEN (CLAYTON SPENCER DDS)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:GLEN
Last Name:SPENCER
Suffix:
Gender:M
Credentials:CLAYTON SPENCER DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 LAMAR AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4492
Mailing Address - Country:US
Mailing Address - Phone:903-739-2288
Mailing Address - Fax:903-739-2044
Practice Address - Street 1:707 LAMAR AVE
Practice Address - Street 2:SUITE L
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4492
Practice Address - Country:US
Practice Address - Phone:903-739-2288
Practice Address - Fax:903-739-2044
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics