Provider Demographics
NPI:1477765295
Name:CLAYBORN, THEANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:THEANDREW
Middle Name:
Last Name:CLAYBORN
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 1:1440 E SHELBY DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7255
Mailing Address - Country:US
Mailing Address - Phone:901-332-8729
Mailing Address - Fax:901-345-9187
Practice Address - Street 1:1440 E SHELBY DR
Practice Address - Street 2:SUITE #5
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7255
Practice Address - Country:US
Practice Address - Phone:901-332-8729
Practice Address - Fax:901-345-9187
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist