Provider Demographics
NPI:1629491931
Name:MCENTIRE, CLAYTON HUGHES (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:HUGHES
Last Name:MCENTIRE
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 W BAY TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7045
Mailing Address - Country:US
Mailing Address - Phone:813-250-0313
Mailing Address - Fax:813-250-0313
Practice Address - Street 1:3516 W BAY TO BAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7045
Practice Address - Country:US
Practice Address - Phone:813-250-0313
Practice Address - Fax:813-250-0313
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL195311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics