Provider Demographics
NPI:1598499071
Name:CLAYTON, ANNA GRACE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:GRACE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-3319
Mailing Address - Country:US
Mailing Address - Phone:662-586-2311
Mailing Address - Fax:
Practice Address - Street 1:209 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-3319
Practice Address - Country:US
Practice Address - Phone:662-586-2311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4309-221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice