Provider Demographics
NPI:1326267261
Name:CLARKSON, TOBY JOHNSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:JOHNSON
Last Name:CLARKSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BYERS RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3937
Mailing Address - Country:US
Mailing Address - Phone:706-745-4890
Mailing Address - Fax:706-745-4890
Practice Address - Street 1:808 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2536
Practice Address - Country:US
Practice Address - Phone:706-281-2206
Practice Address - Fax:706-281-2397
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133161223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223D0001XDental ProvidersDentistDental Public Health
Not Answered1223G0001XDental ProvidersDentistGeneral Practice