Provider Demographics
NPI:1568757151
Name:CAMMACK, CLAY ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:ALEXANDER
Last Name:CAMMACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:ALEX
Other - Last Name:CAMMACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5730 W LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-5116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5730 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-5116
Practice Address - Country:US
Practice Address - Phone:214-352-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist