Provider Demographics
NPI:1275704561
Name:MICHAEL J CLAYMORE DDS
Entity Type:Organization
Organization Name:MICHAEL J CLAYMORE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLAYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-682-4540
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:ID
Mailing Address - Zip Code:83850-0609
Mailing Address - Country:US
Mailing Address - Phone:208-682-4540
Mailing Address - Fax:208-682-2339
Practice Address - Street 1:8 N DIVISION STREET
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:ID
Practice Address - Zip Code:83850-0609
Practice Address - Country:US
Practice Address - Phone:208-682-4540
Practice Address - Fax:208-682-2339
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL J CLAYMORE DDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD1817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDCS3387OtherCONTROLLED SUBSTANCE
IDD1817OtherIDAHO DENTIST NUMBER
IDD1817OtherIDAHO DENTIST NUMBER