Provider Demographics
NPI:1619178480
Name:CLAYTON, LARRY (DDS)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:CLAYTON
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 1:100 VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911-3711
Mailing Address - Country:US
Mailing Address - Phone:406-837-4806
Mailing Address - Fax:
Practice Address - Street 1:100 VILLAGE LN
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911-3711
Practice Address - Country:US
Practice Address - Phone:406-837-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist