Provider Demographics
NPI:1114590114
Name:YODER, CLAYTON WICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:WICK
Last Name:YODER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 RIVERSIDE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1281
Mailing Address - Country:US
Mailing Address - Phone:832-233-0719
Mailing Address - Fax:
Practice Address - Street 1:12709 INTERSTATE 45 N
Practice Address - Street 2:
Practice Address - City:WILLIS
Practice Address - State:TX
Practice Address - Zip Code:77318-7023
Practice Address - Country:US
Practice Address - Phone:936-856-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice