Provider Demographics
NPI:1699828301
Name:DAVIS, CLAYTON EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:EDWARD
Last Name:DAVIS
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 1:613 WATAUGA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4429
Mailing Address - Country:US
Mailing Address - Phone:423-247-7741
Mailing Address - Fax:423-247-7441
Practice Address - Street 1:613 WATAUGA ST
Practice Address - Street 2:SUITE E
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4429
Practice Address - Country:US
Practice Address - Phone:423-247-7741
Practice Address - Fax:423-247-7441
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-83811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9178841Medicaid
TN4123697OtherBLUE CROSS BLUE SHIELD