Provider Demographics
NPI:1407173883
Name:MILLER, CLAYTON JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:JAMES
Last Name:MILLER
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 1:201 MAITLAND AVE
Mailing Address - Street 2:SUITE 1013
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4903
Mailing Address - Country:US
Mailing Address - Phone:407-834-0330
Mailing Address - Fax:
Practice Address - Street 1:201 MAITLAND AVE
Practice Address - Street 2:SUITE 1013
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4903
Practice Address - Country:US
Practice Address - Phone:407-834-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
FLDN 210671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No171000000XOther Service ProvidersMilitary Health Care Provider